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General NPI Number Information
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NPI Number | 1750363149
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Entity Type | Individual
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Provider Name | DAVID A PETERSEN MD
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Gender | Male
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Dates
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Enumeration Date | 11/19/2005
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 4910 DIRECTORS PL STE 350
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City | SAN DIEGO
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State | CA
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Zip | 92121-3834
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Country | US
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Telephone | 844-484-4267
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Fax | 949-381-5687
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Provider Business Mailing Address
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Address Line | 1433 S FORT HARRISON AVE STE D
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City | CLEARWATER
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State | FL
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Zip | 33756-2072
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Country | US
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Telephone | 727-724-3985
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Fax | 727-726-7553
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME54499
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G130506
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License Number State | CA
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