Petersen, Larry D.
Petersen, Larry D. is an individual health care provider with primary practice located at 3801 S National Ave , Springfield MO 65807-5210. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Petersen, Larry D. can be contacted via phone (417) 269-4550.Contact Information
Primary practice address
3801 S National Ave
Springfield MO 65807-5210
Phone: (417) 269-4550
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | MDR7D93 | Missouri |
Profile Details
| NPI number | 1689617771 |
|---|---|
| LBN Legal business name | Petersen, Larry D. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 14th, 2006 |
| Last updated | Jun 28th, 2012 - about 12 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 | 1689617771 | NPPES |
| Missouri | MEDICAID | 202009619 |
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