Provider Demographics
NPI:1114968435
Name:PETERSEN, ANNE E (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:E
Other - Last Name:DABNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:573-815-8145
Mailing Address - Fax:573-815-3832
Practice Address - Street 1:1601 E BROADWAY
Practice Address - Street 2:STE 240
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8020
Practice Address - Country:US
Practice Address - Phone:573-815-8145
Practice Address - Fax:573-815-3832
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006010643208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00344374OtherRAILROAD MEDICARE
MO201431509Medicaid
MOCD6061OtherRAILROAD GROUP
MO767347OtherHEALTHLINK
MO210746OtherBCBS
MO210746OtherBCBS
MOCD6061OtherRAILROAD GROUP