Provider Demographics
NPI:1023111002
Name:PETERSON, JOHN CLEVE III (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLEVE
Last Name:PETERSON
Suffix:III
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 N MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2130
Mailing Address - Country:US
Mailing Address - Phone:206-232-7669
Mailing Address - Fax:206-232-7679
Practice Address - Street 1:7030 N MERCER WAY
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2130
Practice Address - Country:US
Practice Address - Phone:206-232-7669
Practice Address - Fax:206-232-7679
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11059207QA0505X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine