Peterson, Richard Bertram

Peterson, Richard Bertram is an individual health care provider with primary practice located at 1661 Soquel Dr Building G, Santa Cruz CA 95065-1709. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Peterson, Richard Bertram can be contacted via phone (831) 476-1542.

Contact Information

Primary practice address
1661 Soquel Dr Building G Santa Cruz CA 95065-1709
Phone: (831) 476-1542
Fax: (831) 464-8977
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X G28341 California

Profile Details

NPI number 1760496202
LBN Legal business name Peterson, Richard Bertram
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2006
Last updated May 9th, 2008 - about 18 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 1760496202 NPPES
California MEDICAID 00G283410

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