Individual provider · Type 1 NPI

John J. Petersen, PA

Surgical Physician Assistant · Medford, OR

NPI number 1164580429 Active

Practice location

520 Medical Center Dr, Suite 201
Medford, OR 97504-4334

Mailing address

2620 E Barnett Rd, Suite H
Medford, OR 97504-8344

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400XPA00228 (OR)

Surgical Physician Assistant: Definition to come...

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About NPI 1164580429

John J. Petersen, PA's National Provider Identifier is 1164580429, issued on Dec 5, 2006. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Medford, OR. The record was last updated on Jan 16, 2013.