Provider Demographics
NPI:1225234511
Name:PETERSON, DAVID JOHN (DO, PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DO, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3608
Mailing Address - Country:US
Mailing Address - Phone:702-735-7355
Mailing Address - Fax:702-735-7966
Practice Address - Street 1:2800 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3608
Practice Address - Country:US
Practice Address - Phone:702-735-7355
Practice Address - Fax:702-735-7966
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1393207X00000X
OH58.001229207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery