Active NPI
John J Peterson, DPH
- Pharmacist
- Maryville, TN
National Provider Identifier
1780838680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 33314
- Practice address
- 131 Montgomery LN
Maryville, TN 37803-5649 - Phone
- (865) 681-0520
- NPI assigned
- Nov 5, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 33314 | TN | Primary |
Addresses
Primary practice location
131 Montgomery LN
Maryville, TN 37803-5649
Mailing address
1536 Mint Meadows Dr
Maryville, TN 37803-2542
Phone (865) 982-5378
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33314 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1780838680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1536 MINT MEADOWS DR",
"city": "MARYVILLE",
"state": "TN",
"postal_code": "378032542",
"telephone_number": "865-982-5378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 MONTGOMERY LN",
"city": "MARYVILLE",
"state": "TN",
"postal_code": "378035649",
"telephone_number": "865-681-0520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JOHN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-11-05",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "33314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maryville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.