Provider Demographics
NPI:1114584497
Name:PETERSEN, CODY (MD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 WESTOWN PKWY STE 236
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6720
Mailing Address - Country:US
Mailing Address - Phone:515-401-1950
Mailing Address - Fax:515-401-1955
Practice Address - Street 1:4201 WESTOWN PKWY STE 236
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6720
Practice Address - Country:US
Practice Address - Phone:515-401-1950
Practice Address - Fax:515-401-1955
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-11507207L00000X
IAMD-51330207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology