Provider Demographics
NPI:1235171299
Name:PETERSON, MARGARET ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 N LINDA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2311
Mailing Address - Country:US
Mailing Address - Phone:805-643-3101
Mailing Address - Fax:805-643-2828
Practice Address - Street 1:2895 LOMA VISTA RD
Practice Address - Street 2:SUITE #E
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1572
Practice Address - Country:US
Practice Address - Phone:805-643-2895
Practice Address - Fax:805-643-2828
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG064562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF10912Medicare UPIN
CAG64562AMedicare ID - Type Unspecified