MEDICARE: DR. ROBERT KAY PETERSON 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	G84728	CA

General Provider Information

NPI Number	:	1093717951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT KAY PETERSON M.D.

Provider Business Mailing Address
First Line	:	1010 NUT TREE RD
Second Line	:	STE 200
City	:	VACAVILLE
State	:	CA
Zip	:	95687-4172
Country	:	US
Telephone Number	:	707-624-7900
Fax Number	:	707-624-7911

Provider Business Practice Location Address
First Line	:	1010 NUT TREE RD
Second Line	:	STE 200
City	:	VACAVILLE
State	:	CA
Zip	:	95687-4172
Country	:	US
Telephone Number	:	707-624-7900
Fax Number	:	707-624-7901

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/15/2013

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