Petersen, Joseph R

Petersen, Joseph R is an sole proprietor health care provider with primary practice located at 1344 Hiland Ave Ste A , Burley ID 83318-1564. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Petersen, Joseph R can be contacted via phone (208) 678-1138.

Contact Information

Primary practice address
1344 Hiland Ave Ste A Burley ID 83318-1564
Phone: (208) 678-1138
Fax: (208) 678-5833
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X M5283 Idaho

Profile Details

NPI number 1225105604
LBN Legal business name Petersen, Joseph R
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 29th, 2006
Last updated Jul 9th, 2007 - about 18 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 1225105604 NPPES
Idaho Other 000010003563 BLUE SHIELD PROVIDER NO.
Idaho Other C36979 BLUE SHIELD PROVIDER NO.
Idaho Other 014917 BLUE SHIELD PROVIDER NO.
Idaho Other I000490 BLUE SHIELD PROVIDER NO.
Idaho Other 74096 BLUE SHIELD PROVIDER NO.
Idaho Other 0791870001 BLUE SHIELD PROVIDER NO.

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