Active NPI
Jeffrey Peterson, M.D.
- Psychiatry Physician
- Anaheim, CA
National Provider Identifier
1417003567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G69213
- Practice address
- 2911 E Coronado St
Anaheim, CA 92806 - Phone
- (714) 688-4855
- NPI assigned
- Jan 25, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G69213 | CA | Primary |
Addresses
Primary practice location
2911 E Coronado St
Anaheim, CA 92806
Mailing address
21015 Pathfinder Rd
Diamond Bar, CA 91765-4018
Phone (909) 468-2300
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G69213 | CA | MD | Psychiatry Physician |
Interoperability endpoints
- jeffrey.peterson@4285.securemail.prognocis.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554854400000",
"number": "1417003567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21015 PATHFINDER RD",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917654018",
"telephone_number": "909-468-2300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2911 E CORONADO ST",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "92806",
"telephone_number": "714-688-4855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JEFFREY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-25",
"last_updated": "2019-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G69213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.