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NPI Code Detail

MEDICARE: DR. GAIL E PETERSON

MEDICARE: DR. GAIL E PETERSON
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
11223G0001XGeneral Practice Dentistry10458IN

Other Identifiers

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

General Provider Information

NPI Number : 1194739250
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GAIL E PETERSON
Provider Business Mailing Address
First Line : 2526 CENTRAL AVE
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-3121
Country : US
Telephone Number : 812-376-7263
Fax Number :
Provider Business Practice Location Address
First Line : 2526 CENTRAL AVE
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-3121
Country : US
Telephone Number : 812-376-7263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 10/27/2016

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Directions to “ DR. GAIL E PETERSON ” Practice Location

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