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General NPI Number Information
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NPI Number | 1801896766
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Entity Type | Organization
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Legal Business Name | JOHN L PETERSON MD
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 1013 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330-4114
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Country | US
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Telephone | 919-775-8183
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Fax | 919-775-8152
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Provider Business Mailing Address
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Address Line | 1013 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330-4114
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Country | US
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Telephone | 919-775-8183
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Fax | 919-775-8152
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANDREA FAIRCLOTH
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Credential |
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Telephone | 919-775-8183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 38166
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License Number State | NC
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