MEDICARE: HUBERT PETERSON MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	04-22995	KS
2	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	04-22995	KS

General Provider Information

NPI Number	:	1891766812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUBERT PETERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 1258
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67905-1258
Country	:	US
Telephone Number	:	620-626-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1436 N WESTERN AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2212
Country	:	US
Telephone Number	:	620-626-8500
Fax Number	:

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	09/11/2025

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