Provider Demographics
NPI:1548750144
Name:DON PETERSON MD, SUGICAL ASSISTING
Entity Type:Organization
Organization Name:DON PETERSON MD, SUGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:916-425-3447
Mailing Address - Street 1:4219 BUCHANAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628
Mailing Address - Country:US
Mailing Address - Phone:916-425-3447
Mailing Address - Fax:916-961-0301
Practice Address - Street 1:MERCY HOSPITAL OF FOLSOM (DIGNITY HEALTH FOLSOM)
Practice Address - Street 2:1650 CREEKSIDE DR.
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-425-3447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22928208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty