Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | MT210365 | PA |
NPI | 1992124481 |
---|---|
Provider Name | Rosemary G Peterson |
First Address | Austin, TX 78751-2704 |
Second Address | Austin, TX 78723-3078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 20/10/2020 |