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General NPI Number Information
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NPI Number | 1972630564
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Entity Type | Individual
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Provider Name | DANIEL L PETERSON MD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 926 INCLINE WAY UNIT 150
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-7933
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Country | US
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Telephone | 775-832-0989
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Fax | 775-832-3046
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Provider Business Mailing Address
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Address Line | PO BOX 11249
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City | RENO
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State | NV
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Zip | 89510-1249
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Country | US
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Telephone | 775-832-0989
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Fax | 775-832-3046
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4249
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License Number State | NV
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