Provider Demographics
NPI:1477809093
Name:PETERSON, SNOW (DO, MS)
Entity type:Individual
Prefix:DR
First Name:SNOW
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3201
Mailing Address - Country:US
Mailing Address - Phone:707-649-2200
Mailing Address - Fax:
Practice Address - Street 1:525 OREGON ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3201
Practice Address - Country:US
Practice Address - Phone:707-648-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204656207RS0012X
TN3103207RS0012X
CA20A16799207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103IC09431Medicare PIN
VAVVM567B288Medicare PIN