MEDICARE: DR. RICHARD ALLAN 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	208000000X	Pediatrics Physician	G34095	CA

General Provider Information

NPI Number	:	1245214576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALLAN PETERSON M.D.

Provider Business Mailing Address
First Line	:	1050 LAS TABLAS RD
Second Line	:	SUITE 13
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9729
Country	:	US
Telephone Number	:	805-434-1435
Fax Number	:	805-434-3747

Provider Business Practice Location Address
First Line	:	1050 LAS TABLAS RD
Second Line	:	SUITE 13
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9729
Country	:	US
Telephone Number	:	805-434-1435
Fax Number	:	805-434-3747

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	01/10/2014

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