MEDICARE: DR. ERIK THOMAS PETERSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	R6258	TX

General Provider Information

NPI Number	:	1043621048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIK THOMAS PETERSEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4439
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4439
Country	:	US
Telephone Number	:	713-792-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4000
Country	:	US
Telephone Number	:	713-792-6161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	01/15/2026

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