Jeffrey Petersen, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

A36290 Issued in CA

Practice address

300 Pasteur Dr # A175Mc5309
Stanford, CA 94305-2200

Phone

(650) 723-1151

Fax

(650) 723-7917

NPI assigned

Feb 13, 2007

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649312752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR # A175MC5309",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-1151",
            "fax_number": "650-723-7917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR # A175MC5309",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-1151",
            "fax_number": "650-723-7917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JEFFREY",
        "name_prefix": "Prof.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A36290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A362900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Kaulana NA Pua Perras, PA-C
• Suzann Pershing, M.D.
• Mai Xiong Pesusic, PA-C
• Kaitlyn Ann Peters, PA-C
• Miranda Christine Peters, PA
• Suzanne Crowley Petersen, P.A.
• Ashley Michelle Peterson, MD
• Bonnie Kaye Peterson, RN BSN
• Dylan Joseph Peterson
• Janis M. Petree, NP

• Nephrology Physician in Stanford, CA
• Providers in Stanford, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.