Provider Demographics
NPI:1285848838
Name:PETERSON, ERIC WEBSTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WEBSTER
Last Name:PETERSON
Suffix:
Gender:M
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:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-1718
Mailing Address - Country:US
Mailing Address - Phone:828-253-6998
Mailing Address - Fax:
Practice Address - Street 1:77 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3623
Practice Address - Country:US
Practice Address - Phone:828-253-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC174112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8967215Medicaid
NC033527OtherVALUE OPTIONS
NC67215OtherBLUE CROSS
1567Medicare PIN