Dr. Larry Len Peterson
Dermatologist
16877 65th Ave
Lake Oswego
, Oregon 97035-7865
Dr. Larry Len Peterson
Dermatologist
16877 65th Ave
Lake Oswego
, Oregon 97035-7865
(503) 684-8554
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Dr. Larry Len Peterson
- 16877 65th Ave
- Lake Oswego, OR
- Zip : 97035-7865
- Fax : (503) 684-8554
- Phone : (503) 620-3376
Second Address
- Dr. Larry Len Peterson
- 16877 65th Ave
- Lake Oswego, OR
- Zip : 97035-7865
- Fax : (503) 684-8554
- Phone : (503) 620-3376
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | MD12848 | OR |
National Provider Identifier
| NPI | 1043273907 |
|---|---|
| Provider Name | Dr. Larry Len Peterson |
| First Address | Lake Oswego, OR 97035-7865 |
| Second Address | Lake Oswego, OR 97035-7865 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/04/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 3542298 | LIFEWISE (01) | OR |
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.