Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6102 | OR |
Y | 213EG0000X | General Practice | 6102 | OR |
NPI | 1003815085 |
---|---|
Provider Name | Dr. Janet P Peterson |
First Address | Corvallis, OR 97333-2031 |
Second Address | Corvallis, OR 97330-6352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
193607 | (05) | OR |