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General NPI Number Information
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NPI Number | 1649250242
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Entity Type | Individual
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Provider Name | SCOTT M PETERSON MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 3300 W CENTRE AVE BRONSON OB GYN ASSOCIATES
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City | PORTAGE
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State | MI
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Zip | 49024-4666
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Country | US
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Telephone | 269-327-2211
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Fax | 269-327-0273
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Provider Business Mailing Address
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Address Line | 601 JOHN ST BOX 42
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City | KALAMAZOO
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State | MI
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Zip | 49007-5341
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Country | US
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Telephone | 269-341-7806
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Fax | 269-341-8743
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301068138
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License Number State | MI
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