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NPI Code Detail

MEDICARE: TIMOTHY PETERSON M.D.

MEDICARE: TIMOTHY 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
1207Q00000XFamily Medicine PhysicianLL2279NV

General Provider Information

NPI Number : 1922362490
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY PETERSON M.D.
Provider Business Mailing Address
First Line : 4235 SOUTHWEST BLVD
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-5635
Country : US
Telephone Number : 325-747-1511
Fax Number : 325-747-4108
Provider Business Practice Location Address
First Line : 4235 SOUTHWEST BLVD
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-5635
Country : US
Telephone Number : 325-747-1511
Fax Number : 325-747-4108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2012
Last Update Date : 06/30/2025

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Directions to “ TIMOTHY PETERSON M.D.” Practice Location

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