Joseph R. Petersen, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

M5283 Issued in ID

Legal business name

JOSEPH R. PETERSEN, M.D.

Practice address

1344 Hiland Ave Ste a
Burley, ID 83318-1564

Phone

(208) 678-1138

Fax

(208) 678-5833

NPI assigned

Mar 19, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Joseph R Petersen I, M.D.NPI 1225105604

Title

Physician/Owner

Phone

(208) 678-1138

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Orthopedic Surgery Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph R Petersen

  • Specialist
  • Burley, ID
  • NPI 1225105604
  NPD (past) Authorized official

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205884800000",
    "number": "1790956514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1344 HILAND AVE STE A",
            "address_2": "P. O. BOX 1263",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833181564",
            "telephone_number": "208-678-1138",
            "fax_number": "208-678-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 HILAND AVE STE A",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833181564",
            "telephone_number": "208-678-1138",
            "fax_number": "208-678-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH R. PETERSEN, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2008-03-19",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "208-678-1138",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "M5283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIV",
            "identifier": "1225105604",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthopedic Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evan Johnson, PA-C
• Jared C Johnson, D.D.S.
• Anita Engstrom Jones, LCPC, LMFT
• Jennifer Anne Jones, COUI-9582
• Joseph R. Petersen, M.D.
• JRT Healthcare, Inc.
• JRT Healthcare, Inc.
• Ellen K Judd, P.A.
• Justin D Ward DMD MSD PLLC
• K2Red L.L.C.

• Specialist in Burley, ID
• Providers in Burley, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.