Petersen, Glen W.

Petersen, Glen W. is an individual health care provider with primary practice located at 411 30Th St Suite 314, Oakland CA 94609-3312. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Petersen, Glen W. can be contacted via phone (510) 465-6800.

Contact Information

Primary practice address
411 30Th St Suite 314 Oakland CA 94609-3312
Phone: (510) 465-6800
Fax: (510) 268-0634
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X A26004 California
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X A26004 California

Profile Details

NPI number 1467495986
LBN Legal business name Petersen, Glen W.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Jan 14th, 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1467495986 NPPES
California MEDICAID 00A260040

Popular Providers