Provider Demographics
NPI:1982863106
Name:PETERSON, BETHANY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21700 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2545
Mailing Address - Country:US
Mailing Address - Phone:281-398-8639
Mailing Address - Fax:281-398-5019
Practice Address - Street 1:21700 KINGSLAND BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2545
Practice Address - Country:US
Practice Address - Phone:281-398-8639
Practice Address - Fax:281-398-5019
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2017-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM8248207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology