MEDICARE: DR. ANDREW CLAIR 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	207R00000X	Internal Medicine Physician	MDO9438	OR
2	207R00000X	Internal Medicine Physician	M6155	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093779365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW CLAIR PETERSON M.D.

Provider Business Mailing Address
First Line	:	1050 SW 3RD AVE
Second Line	:	#3200
City	:	ONTARIO
State	:	OR
Zip	:	97914-2193
Country	:	US
Telephone Number	:	541-881-7373
Fax Number	:	541-881-7186

Provider Business Practice Location Address
First Line	:	1050 SW 3RD AVE
Second Line	:	#3200
City	:	ONTARIO
State	:	OR
Zip	:	97914-2193
Country	:	US
Telephone Number	:	541-881-7373
Fax Number	:	541-881-7186

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	02/04/2009

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Directions to “ DR. ANDREW CLAIR PETERSON M.D.” Practice Location

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