Provider Demographics
NPI:1558538082
Name:DAVID O. PETERSON, D.O., P.C.
Entity Type:Organization
Organization Name:DAVID O. PETERSON, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-772-9296
Mailing Address - Street 1:200 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1692
Mailing Address - Country:US
Mailing Address - Phone:616-772-9296
Mailing Address - Fax:616-772-9789
Practice Address - Street 1:200 TAFT ST
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1692
Practice Address - Country:US
Practice Address - Phone:616-772-9296
Practice Address - Fax:616-772-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty