Provider Demographics
NPI:1528024072
Name:PETERSON, W JOSEPH (DOM, AP)
Entity Type:Individual
Prefix:DR
First Name:W JOSEPH
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 COBBLESTONE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BAYONET POINT
Mailing Address - State:FL
Mailing Address - Zip Code:34667-2487
Mailing Address - Country:US
Mailing Address - Phone:727-378-7469
Mailing Address - Fax:
Practice Address - Street 1:12100 COBBLESTONE DR STE 3
Practice Address - Street 2:
Practice Address - City:BAYONET POINT
Practice Address - State:FL
Practice Address - Zip Code:34667-2487
Practice Address - Country:US
Practice Address - Phone:727-378-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP-1568171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-0088566OtherJOSEPH PETERSON ACUPUNCTU