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General NPI Number Information
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NPI Number | 1770087710
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Entity Type | Individual
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Provider Name | JOEL PETERSON MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 3650 NW 82ND AVE STE 103
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City | DORAL
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State | FL
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Zip | 33166-6662
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Country | US
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Telephone | 305-227-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 NW 82ND AVE STE 103
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City | DORAL
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State | FL
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Zip | 33166-6662
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Country | US
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Telephone | 703-314-3238
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Fax |
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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 | 321520
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License Number State | NY
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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 | ME168223
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License Number State | FL
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