Richard Bertram Peterson, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G28341 Issued in CA

Practice address

1661 Soquel Dr
Building G
Santa Cruz, CA 95065-1709

Phone

(831) 476-1542

Fax

(831) 464-8977

NPI assigned

Jul 28, 2006

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

State licenses

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210291200000",
    "number": "1760496202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 SOQUEL DR",
            "address_2": "BUILDING G",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651709",
            "telephone_number": "831-476-1542",
            "fax_number": "831-464-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 SOQUEL DR",
            "address_2": "BUILDING G",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651709",
            "telephone_number": "831-476-1542",
            "fax_number": "831-464-8977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RICHARD",
        "middle_name": "BERTRAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2008-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G28341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G283410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olivia Starr Peters-Lazaro, L.AC.
• Natalie Suzanne Petersen, L.AC.
• Annemieke Peterson, D.C.
• Hanna Clare Peterson
• Matthew Christopher Peterson, RBT
• Ryan Peterson
• Shawn William Peterson
• Alfred Petrocelli
• Andreea Georgiana Petruse
• Randi Marie Pfaff

• Diagnostic Radiology Physician in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.