Petersen, James H

Petersen, James H is an individual health care provider with primary practice located at 200 Brevco Plz Suite 208, Lake St Louis MO 63367-2949. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Petersen, James H can be contacted via phone (636) 561-9020.

Contact Information

Primary practice address
200 Brevco Plz Suite 208 Lake St Louis MO 63367-2949
Phone: (636) 561-9020
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X MOR7B69 Missouri

Profile Details

NPI number 1831169275
LBN Legal business name Petersen, James H
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2006
Last updated Jul 18th, 2014 - about 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831169275 NPPES
Missouri MEDICAID 1831169275
Missouri Other P01021819
Missouri Other 24528
Missouri MEDICAID 202263828

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