Kenneth Percy Peterson, MD, Inc.

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

C50553 Issued in CA

Legal business name

KENNETH PERCY PETERSON, MD, INC.

Practice address

16850 Bear Valley Rd
Victorville, CA 92395-5794

Phone

(760) 241-8000

NPI assigned

Feb 10, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Percy Peterson, MD

Title

President

Phone

(805) 796-4595

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1184015380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12155 MESQUITE ST",
            "city": "OAK HILLS",
            "state": "CA",
            "postal_code": "923447903",
            "telephone_number": "805-796-4595",
            "fax_number": "760-662-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16850 BEAR VALLEY RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955794",
            "telephone_number": "760-241-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH PERCY PETERSON, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "PERCY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-796-4595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "C50553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Acute Care Hospital in Victorville, CA
• Providers in Victorville, CA by specialty
• General Acute Care Hospital in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.