PAUL D PETERSON PA NPI 1861494486

NPI Information

NPI: 1861494486
Provider Name: PAUL D PETERSON, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
2207 S CLEAR CREEK RD
STE 304
KILLEEN, TX
ZIP 76549
Phone: (254) 526-2085
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Paul D Peterson, PA is a medical physician assistant in Killeen, TX. Paul D Peterson, PA NPI is 1861494486. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2207 S CLEAR CREEK RD
STE 304
KILLEEN, TX
ZIP 76549-132
Phone: (254) 526-2085
Fax: (254) 526-9569

The enumeration date for this NPI number is 8/12/2005 and was last updated on 10/24/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0000X	Internal Medicine	Cardiovascular Disease	PA01398	TEXAS	No
2	363AM0700X	Physician Assistant	Medical	PA01398	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	85N216	OTHER	TEXAS	BC/BS
2	S41040	MEDICARE UPIN
3	85N216	MEDICARE PIN	TEXAS
4	8SN216	MEDICARE ID-TYPE UNSPECIFIED	TEXAS
5	8AS486	MEDICARE ID-TYPE UNSPECIFIED	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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