Dr. Jeffrey E Petersen
Dermatologist MOHS-Micrographic Surgeon
1011 Bowles Ave Suite 121
Fenton
, Missouri 63026-2395
Dr. Jeffrey E Petersen
Dermatologist MOHS-Micrographic Surgeon
1011 Bowles Ave Suite 121
Fenton
, Missouri 63026-2395
(314) 200-2714
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About
Features
Specialties
- Dermatologist
- MOHS-Micrographic Surgeon
Languages spoken
- English
Location
First Address
- Dr. Jeffrey E Petersen
- 1011 Bowles Ave Suite 121
- Fenton, MO
- Zip : 63026-2395
- Fax : (314) 200-2714
- Phone : (314) 200-2713
Second Address
- Dr. Jeffrey E Petersen
- 1011 Bowles Ave Suite 121
- Fenton, MO
- Zip : 63026-2395
- Fax : (314) 200-2714
- Phone : (314) 200-2713
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 2001020599 | MO |
| N | 207ND0101X | MOHS-Micrographic Surgeon | 2001020599 | MO |
National Provider Identifier
| NPI | 1275551707 |
|---|---|
| Provider Name | Dr. Jeffrey E Petersen |
| First Address | Fenton, MO 63026-2395 |
| Second Address | Fenton, MO 63026-2395 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/07/2006 |
| Last Update Date | 25/07/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 146422 | MO-BLUE SHIELD (01) | |
| 205401409 | (05) | MO |
| 3177332 | CIGNA (01) | MO |
| 703212 | AETNA (01) | MO |
| 853972 | ANTHEM (01) | MO |
| H28257 | (02) |
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.