Provider Demographics
NPI:1336400456
Name:PETERSON, JEREMY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:CHARLES
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2106 OLATHE BLVD MS 3021
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6122
Mailing Address - Fax:913-535-2201
Practice Address - Street 1:UNIVERSITY OF KANSAS HOSPITAL SCHOOL OF
Practice Address - Street 2:DEPT. OF NEUROSURGERY, 3901 RAINBOW BLVD., MS 3021
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6119
Practice Address - Fax:913-588-7570
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2021-09-03
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Provider Licenses
StateLicense IDTaxonomies
KS94-07818207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery