Provider Demographics
NPI:1376395400
Name:PETERSON, ERIC TAYLOR (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:TAYLOR
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:TAYLOR
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:VALLEY HOSPITAL MEDICAL CENTER
Mailing Address - Street 2:620 SHADOW LANE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:707-388-8436
Mailing Address - Fax:
Practice Address - Street 1:2335 STOCKTON BLVD FL 5
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2724
Practice Address - Fax:916-734-5633
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program