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NPI Code Detail

MEDICARE: MR. RONALD EUGENE PETERSON JR.

MEDICARE: MR. RONALD EUGENE PETERSON JR.
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1861349391
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD EUGENE PETERSON JR.
Provider Business Mailing Address
First Line : 5707 N 22ND ST
Second Line :
City : TAMPA
State : FL
Zip : 33610-4350
Country : US
Telephone Number : 813-239-8115
Fax Number :
Provider Business Practice Location Address
First Line : 5707 N 22ND ST
Second Line :
City : TAMPA
State : FL
Zip : 33610-4350
Country : US
Telephone Number : 813-239-8115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2026
Last Update Date : 03/13/2026

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Directions to “ MR. RONALD EUGENE PETERSON JR. ” Practice Location

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