Provider Demographics
NPI:1164983086
Name:PETERSON, THOMAS REX (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:REX
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FAU EMERGENCY MEDICINE, BETHESDA HOSPITAL EAST
Mailing Address - Street 2:ATTN: JOANNE DALY, 2815 S. SEACREST BLVD.
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435
Mailing Address - Country:US
Mailing Address - Phone:561-733-5933
Mailing Address - Fax:866-617-8268
Practice Address - Street 1:FAU EMERGENCY MEDICINE, BETHESDA HOSPITAL EAST
Practice Address - Street 2:ATTN: JOANNE DALY, 2815 S. SEACREST BLVD.
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-733-5933
Practice Address - Fax:866-617-8268
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine