JOHN J PETERSEN PA NPI 1164580429

NPI Information

NPI: 1164580429
Provider Name: JOHN J PETERSEN, PA
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

Address:
520 MEDICAL CENTER DR
SUITE 201
MEDFORD, OR
ZIP 97504
Phone: (541) 789-5710
Get Directions

John J Petersen, PA is a surgical physician assistant in Medford, OR. John J Petersen, PA NPI is 1164580429. 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:

520 MEDICAL CENTER DR
SUITE 201
MEDFORD, OR
ZIP 97504-334
Phone: (541) 789-5710

The enumeration date for this NPI number is 12/5/2006 and was last updated on 1/16/2013.

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	363AS0400X	Physician Assistant	Surgical	PA00228	OREGON	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	R164473	MEDICARE PIN	OREGON
2	500613512	MEDICAID	OREGON

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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