| Jeannette Peterson Md Inc | |
|
1261 Travis Blvd Suite 100 Fairfield CA 94533-4897 | |
| (707) 422-0543 | |
| (707) 422-0549 |
| Full Name | Jeannette Peterson Md Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1261 Travis Blvd, Fairfield, California |
| Authorized Official Name and Position | Jeannette Peterson (PRESIDENT) |
| Authorized Official Contact | 7074220543 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeannette Peterson Md Inc 1261 Travis Blvd Suite 100 Fairfield CA 94533-4897 Ph: (707) 422-0543 | Jeannette Peterson Md Inc 1261 Travis Blvd Suite 100 Fairfield CA 94533-4897 Ph: (707) 422-0543 |
| NPI Number | 1194735811 |
|---|---|
| Provider Enumeration Date | 08/08/2006 |
| Last Update Date | 07/18/2011 |
| Medicare PECOS PAC ID | 8022922897 |
|---|---|
| Medicare Enrollment ID | O20031117000150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194735811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A76492 (California) | Primary |
| Provider Name | Jeannette Peterson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063455954 PECOS PAC ID: 5395659171 Enrollment ID: I20031120000938 |
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