James H Petersen MD PC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MD08688 Issued in OR

Legal business name

JAMES H PETERSEN MD PC

Practice address

900 Sunset Drive
Grande Rhoode Hospital
La Grande, OR 97850

Phone

(541) 963-1401

Fax

(541) 963-1502

NPI assigned

May 19, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James H Petersen, MD PC

Title

President Owner

Phone

(503) 297-7223

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780638411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5319 SW WESTGATE DR",
            "address_2": "#241",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212432",
            "telephone_number": "503-297-7223",
            "fax_number": "503-297-7603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SUNSET DRIVE",
            "address_2": "GRANDE RHOODE HOSPITAL",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "97850",
            "telephone_number": "541-963-1401",
            "fax_number": "541-963-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES H PETERSEN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "503-297-7223",
        "authorized_official_credential": "MD PC"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD08688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "062013",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in La Grande, OR
• Providers in La Grande, OR by specialty
• Anesthesiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.