Provider Demographics
NPI:1245214576
Name:PETERSON, RICHARD ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLAN
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1050 LAS TABLAS RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9729
Mailing Address - Country:US
Mailing Address - Phone:805-434-1435
Mailing Address - Fax:805-434-3747
Practice Address - Street 1:1050 LAS TABLAS RD
Practice Address - Street 2:SUITE 13
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9729
Practice Address - Country:US
Practice Address - Phone:805-434-1435
Practice Address - Fax:805-434-3747
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG34095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics