Michael Alex Peterson, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

18593 Issued in CA

Practice address

1425 Leimert Blvd
Suite 403
Oakland, CA 94602-1865

Phone

(510) 531-0500

Fax

(510) 336-0902

NPI assigned

Jun 16, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Alex Peterson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245110400000",
    "number": "1699902759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 LEIMERT BLVD",
            "address_2": "SUITE 403",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946021865",
            "telephone_number": "510-531-0500",
            "fax_number": "510-336-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 LEIMERT BLVD",
            "address_2": "SUITE 403",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946021865",
            "telephone_number": "510-531-0500",
            "fax_number": "510-336-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MICHAEL",
        "middle_name": "ALEX",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-16",
        "last_updated": "2009-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "18593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEX",
            "last_name": "PETERSON",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Chad Peterson, RNFA
• Dagnija M Peterson, P.T.
• Ellen Tanner Peterson, RN, CPNP, MSN
• Janis Marie Peterson
• Kay Peterson, LMFT
• Ralph L Peterson, MD
• Richard O Peterson, DPT
• Wendy White Peterson, NP
• Sandra Joanne Pethan
• Alana Petland

• Clinical Neuropsychologist in Oakland, CA
• Providers in Oakland, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; 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.