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General NPI Number Information
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NPI Number | 1952726242
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Entity Type | Organization
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Legal Business Name | BRADLEY M. PETERSON, M.D., INC.
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 3030 CHILDRENS WAY #115
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City | SAN DIEGO
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State | CA
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Zip | 92123-4232
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Country | US
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Telephone | 858-966-5863
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Fax | 858-279-8415
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Provider Business Mailing Address
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Address Line | 3030 CHILDRENS WAY #115
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City | SAN DIEGO
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State | CA
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Zip | 92123-4232
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Country | US
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Telephone | 858-966-5863
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Fax | 858-279-8415
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY MORRIS PETERSON
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Credential | M.D.
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Telephone | 858-966-5863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | G21961
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | G21961
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License Number State | CA
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