Paul David Peterson, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

17851 Issued in OK

Practice address

4812 S 109TH East Ave
Suite 300
Tulsa, OK 74146-5826

Phone

(918) 392-1400

Fax

(918) 236-4587

NPI assigned

Jun 23, 2006

Last updated

Feb 10, 2017By the provider in NPPES

Sex

Male

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: paul.peterson@direct.stjohnhealthsystem.com
• Direct secure messaging: paul.peterson@tbja.gwaydirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Broken Arrow Bone and Joint Specialists, PC

  • Orthopaedic Surgery Physician
  • Broken Arrow, OK
  • NPI 1194751834
  NPD (past) Authorized official
• Osu Health System Anesthesia

  • Anesthesiology Physician
  • Columbus, OH
  • NPI 1174581185
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486684800000",
    "number": "1427084318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4802 S 109TH EAST AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465822",
            "telephone_number": "918-392-1400",
            "fax_number": "918-392-1488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4812 S 109TH EAST AVE",
            "address_2": "SUITE 300",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465826",
            "telephone_number": "918-392-1400",
            "fax_number": "918-236-4587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PAUL",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2017-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OK",
            "license": "17851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7822481",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100173870A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4207831",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Peterson
• Lacy Annette Peterson, M.S., CCC-SLP
• Michael L Peterson, D.C.
• Natalie Peterson
• Pamela E Peterson
• Rowdy Adam Peterson
• Tara Peterson
• Timothy Kent Peterson, LPC, LMFT
• Jacqueline Petray, M.D.
• Kelly Janell Petree

• Orthopaedic Surgery Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Orthopaedic Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; 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.