Petersen, Jeffrey E

Petersen, Jeffrey E is an individual health care provider with primary practice located at 1011 Bowles Ave Suite 121, Fenton MO 63026-2395. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Petersen, Jeffrey E can be contacted via phone (314) 200-2713.

Contact Information

Primary practice address
1011 Bowles Ave Suite 121 Fenton MO 63026-2395
Phone: (314) 200-2713
Fax: (314) 200-2714
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 2001020599 Missouri
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 2001020599 Missouri

Profile Details

NPI number 1275551707
LBN Legal business name Petersen, Jeffrey E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated Jul 25th, 2014 - about 10 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 1275551707 NPPES
Missouri Other 703212 AETNA
Missouri Other 146422 AETNA
Missouri MEDICAID 205401409 AETNA
Missouri Other 853972 AETNA
Missouri Other 3177332 AETNA

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