Active NPI
Douglas Charles Peterson, MD
- General Practice Physician
- Elk Grove, CA
National Provider Identifier
1174739288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- G42408
- Practice address
- 9260 Laguna Springs Dr
Suite E2-308
Elk Grove, CA 95758-7947 - Phone
- (916) 691-9574
- NPI assigned
- May 15, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G42408 | CA | |
| General Practice Physician | 208D00000X | G42408 | CA | Primary |
| Legal Medicine (M.D./D.O.) Physician | 209800000X | G42408 | CA |
Addresses
Primary practice location
9260 Laguna Springs Dr
Suite E2-308
Elk Grove, CA 95758-7947
Mailing address
PO Box 588500
Suite E2-308
Elk Grove, CA 95758-8500
Phone (916) 691-9574
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G42408 | CA | MD | Legal Medicine (M.D./D.O.) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366588800000",
"number": "1174739288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 588500",
"address_2": "SUITE E2-308",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957588500",
"telephone_number": "916-691-9574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9260 LAGUNA SPRINGS DR",
"address_2": "SUITE E2-308",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957587947",
"telephone_number": "916-691-9574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DOUGLAS",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2013-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G42408",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "G42408",
"primary": true
},
{
"code": "209800000X",
"taxonomy_group": "",
"desc": "Legal Medicine",
"state": "CA",
"license": "G42408",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.