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General NPI Number Information
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NPI Number | 1780638411
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Entity Type | Organization
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Legal Business Name | JAMES H PETERSEN MD PC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 SUNSET DRIVE GRANDE RHOODE HOSPITAL
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City | LA GRANDE
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State | OR
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Zip | 97850
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Country | US
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Telephone | 541-963-1401
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Fax | 541-963-1502
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Provider Business Mailing Address
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Address Line | 5319 SW WESTGATE DR #241
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City | PORTLAND
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State | OR
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Zip | 97221-2432
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Country | US
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Telephone | 503-297-7223
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Fax | 503-297-7603
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | JAMES H PETERSEN
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Credential | MD PC
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Telephone | 503-297-7223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD08688
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License Number State | OR
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