John David Peterson, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

59.000337 Issued in OH

Practice address

8300 Carmel Ave NE
#501
Albuquerque, NM 87122-3147

Phone

(505) 797-1001

NPI assigned

Nov 15, 2010

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 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": "1289779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374019200000",
    "number": "1780985234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3821 MOUNT RAINIER DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871114356",
            "telephone_number": "276-644-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 CARMEL AVE NE",
            "address_2": "#501",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871223147",
            "telephone_number": "505-797-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-15",
        "last_updated": "2013-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "59.000337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO LISCENSE TRAINING CERTIFICATE",
            "identifier": "59.000337",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dustin James Peterson, DMD
• Elizabeth Peterson
• Gretchen Gilbertson Peterson, D.C.
• Jay Wademan Peterson, CNP
• Jeffrey Peterson
• Jordan Peterson
• Justin Peterson, LPCC
• Kaitlin M Peterson, M.D.
• Kathleen Marie Peterson, RN
• Kimberly Marie Peterson, CPSW

• Foot & Ankle Surgery Podiatrist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Foot & Ankle Surgery Podiatrist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; 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.