Provider Demographics
NPI:1467491076
Name:PETERSON, JEFF REGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:REGAN
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1909 214TH ST SE STE 211
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4418
Mailing Address - Country:US
Mailing Address - Phone:425-248-2626
Mailing Address - Fax:425-248-2627
Practice Address - Street 1:1909 214TH ST SE STE 211
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4418
Practice Address - Country:US
Practice Address - Phone:425-248-2626
Practice Address - Fax:425-248-2627
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037674207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology