NPIMap

Organization Active NPI

Jeannette Peterson MD Inc

  • Primary Care Clinic/Center
  • Fairfield, CA
National Provider Identifier
1194735811
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A76492 Issued in CA
Legal business name
JEANNETTE PETERSON MD INC
Practice address
1261 Travis Blvd
Suite 100
Fairfield, CA 94533-4897
Phone
(707) 422-0543
Fax
(707) 422-0549
NPI assigned
Aug 8, 2006
Last updated
Jul 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

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

Authorized official

Name
Jeannette Peterson, MDNPI 1063455954
Title
President
Phone
(707) 422-0543

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A76492 CA Primary

Addresses

Primary practice location

1261 Travis Blvd
Suite 100
Fairfield, CA 94533-4897

Mailing address

1261 Travis Blvd
Suite 100
Fairfield, CA 94533-4897
Phone (707) 422-0543

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1194735811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1261 TRAVIS BLVD",
            "address_2": "SUITE 100",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334897",
            "telephone_number": "707-422-0543",
            "fax_number": "707-422-0549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 TRAVIS BLVD",
            "address_2": "SUITE 100",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334897",
            "telephone_number": "707-422-0543",
            "fax_number": "707-422-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANNETTE PETERSON MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-422-0543",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A76492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; 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.