Peterson, Mark W

Peterson, Mark W is an individual health care provider with primary practice located at 415 6Th St , Lewiston ID 83501-2431. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Peterson, Mark W can be contacted via phone (208) 799-5335.

Contact Information

Primary practice address
415 6Th St Lewiston ID 83501-2431
Phone: (208) 799-5335
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X M5240 Idaho
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X M5240 Idaho

Profile Details

NPI number 1356312524
LBN Legal business name Peterson, Mark W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 27th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356312524 NPPES
Other P00165374 RAILROAD MEDICARE
Other 0192980 RAILROAD MEDICARE
Other 000010005909 RAILROAD MEDICARE
Other 71498 RAILROAD MEDICARE
MEDICAID 8156473 RAILROAD MEDICARE

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