Provider Demographics
NPI:1023230729
Name:PETERSON, DAVID ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9633 BITTER MELON DR
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-5917
Mailing Address - Country:US
Mailing Address - Phone:919-639-8900
Mailing Address - Fax:919-639-9500
Practice Address - Street 1:9633 BITTER MELON DR
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5917
Practice Address - Country:US
Practice Address - Phone:919-639-8900
Practice Address - Fax:919-639-9500
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA87648208600000X
IN01080233A2086S0129X
NC2008-007972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A876480Medicaid
CA00A876480Medicare PIN