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General NPI Number Information
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NPI Number | 1902249592
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Entity Type | Individual
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Provider Name | JENNIFER ELIZABETH PETERSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 4802 S 109TH EAST AVE
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City | TULSA
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State | OK
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Zip | 74146-5822
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Country | US
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Telephone | 918-392-1400
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Fax | 918-392-1488
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Provider Business Mailing Address
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Address Line | 4802 S 109TH EAST AVE
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City | TULSA
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State | OK
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Zip | 74146-5822
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Country | US
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Telephone | 918-392-1513
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Fax | 918-392-1590
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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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 35.133869
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 34618
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License Number State | OK
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