Pamela O Petersen, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A49282 Issued in CA

Practice address

2330 W Covell Blvd
Davis, CA 95616-5658

Phone

(530) 756-2364

Fax

(530) 756-5817

NPI assigned

Sep 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Miss Pamela Jane Oldham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210032000000",
    "number": "1255430716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 W COVELL BLVD",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165658",
            "telephone_number": "530-756-2364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 W COVELL BLVD",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165658",
            "telephone_number": "530-756-2364",
            "fax_number": "530-756-5817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "PAMELA",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A49282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A492820",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A492820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAMELA",
            "last_name": "OLDHAM",
            "middle_name": "JANE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shawna Marie Perlman, FNP
• Permanente Medical Group
• Alicia M Perry, LPC, LPCC
• Nick Robert Perry
• Michael S Petersen, M.D.
• Kimberly A Peterson, OT
• Elizabeth Petteys
• Ellen J. Pettit, PH.D
• Brandy Pham, RPH
• Elizabeth W Pham, MD

• Pediatrics Physician in Davis, CA
• Providers in Davis, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; 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.