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General NPI Number Information
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NPI Number | 1972506442
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Entity Type | Individual
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Provider Name | JOHN PETERSEN MD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 4705 BRIARWOOD AVENUE
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City | MIDLAND
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State | TX
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Zip | 79707-2639
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Country | US
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Telephone | 432-505-4145
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Fax | 833-941-0864
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Provider Business Mailing Address
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Address Line | 4705 BRIARWOOD AVENUE
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City | MIDLAND
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State | TX
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Zip | 79707-2639
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Country | US
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Telephone | 432-505-4145
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Fax | 833-941-0864
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G74917
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | Q0536
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License Number State | TX
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