Petersen, John J
Petersen, John J is an individual health care provider with primary practice located at 520 Medical Center Dr Suite 201, Medford OR 97504-4334. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Petersen, John J can be contacted via phone (541) 789-5710.Contact Information
Primary practice address
520 Medical Center Dr Suite 201
Medford OR 97504-4334
Phone: (541) 789-5710
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | PA00228 | Oregon |
Profile Details
| NPI number | 1164580429 |
|---|---|
| LBN Legal business name | Petersen, John J |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 5th, 2006 |
| Last updated | Jan 16th, 2013 - about 13 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 | 1164580429 | NPPES |
| Oregon | MEDICAID | 500613512 |
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