Provider Demographics
NPI:1457690737
Name:PETERSON, HERBERT W (M D)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:W
Last Name:PETERSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SUGARLOAF DR
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1624
Mailing Address - Country:US
Mailing Address - Phone:415-435-1101
Mailing Address - Fax:
Practice Address - Street 1:112 SUGARLOAF DR
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1624
Practice Address - Country:US
Practice Address - Phone:415-435-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE266522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry