Dale Edmund Petersen JR.
Prosthetist
4299 3rd Ave
Marianna
, Florida 32446-2136
Dale Edmund Petersen JR.
Prosthetist
4299 3rd Ave
Marianna
, Florida 32446-2136
(850) 526-0063
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About
Features
Specialties
- Prosthetist
Languages spoken
- English
Location
First Address
- Dale Edmund Petersen JR.
- Po Box 430
- Marianna, FL
- Zip : 32447-0430
- Phone : (850) 526-0063
Second Address
- Dale Edmund Petersen JR.
- 4299 3rd Ave
- Marianna, FL
- Zip : 32446-2136
- Fax : (850) 526-1317
- Phone : (850) 526-0063
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 224P00000X | Prosthetist | PRO66 | FL |
National Provider Identifier
| NPI | 1184827693 |
|---|---|
| Provider Name | Dale Edmund Petersen JR. |
| First Address | Marianna, FL 32447-0430 |
| Second Address | Marianna, FL 32446-2136 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 11/06/2007 |
| Last Update Date | 28/03/2008 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.