Petersen, David A
Petersen, David A is an individual health care provider with primary practice located at 2315 8Th St , Lewiston ID 83501-7301. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Petersen, David A can be contacted via phone (208) 746-1383.Contact Information
Primary practice address
2315 8Th St
Lewiston ID 83501-7301
Phone: (208) 746-1383
Fax: (208) 746-6348
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M4779 | Idaho |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD00026059 | Washington |
Profile Details
| NPI number | 1619050424 |
|---|---|
| LBN Legal business name | Petersen, David A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 23rd, 2006 |
| Last updated | Jan 18th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619050424 | NPPES |
| Washington | Other | 31256 | WA LABOR & INDUSTRIES |
| Washington | MEDICAID | 2009450 | WA LABOR & INDUSTRIES |
| Washington | Other | 1116491 | WA LABOR & INDUSTRIES |
| Washington | MEDICAID | 1619050424 | WA LABOR & INDUSTRIES |
| Washington | Other | 1619050424 | WA LABOR & INDUSTRIES |
| Washington | Other | 80094286 | WA LABOR & INDUSTRIES |
| Washington | Other | DF573 | WA LABOR & INDUSTRIES |
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