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General NPI Number Information
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NPI Number | 1639710882
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Entity Type | Organization
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Legal Business Name | PETERSEN NEUROSPINE, PLLC
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 6701 AIRPORT BLVD BUILDING D SUITE 100
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City | MOBILE
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State | AL
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Zip | 36608-6765
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Country | US
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Telephone | 251-607-6117
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Fax | 251-219-0746
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Provider Business Mailing Address
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Address Line | 6701 AIRPORT BLVD BUILDING D SUITE 100
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City | MOBILE
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State | AL
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Zip | 36608-6765
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Country | US
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Telephone | 251-607-6117
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Fax | 251-219-0746
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BENDT P PETERSEN III
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Credential | MD
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Telephone | 251-607-6117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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