KENNY J PETERSON (NPI# 1104815315) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104815315 |
| Entity Type | Individual |
| Full Name | KENNY J PETERSON |
| Credential | M.D. |
| Practice Address |
35 Mdos/sgopo Misawa Ab AP 96319 JP |
| Mailing Address |
Psc 76 Box 7634 Apo AP 96319 JP |
| Practice Telephone | 315-226-6150 |
| Practice Fax Number | 315-226-6271 |
| Mailing Telephone | 315-226-6150 |
| Mailing Fax Number | 315-226-6271 |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 35-07-3341-P | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | STATE LICENSE | 35-07-3341-P | 01 |
| Street Address |
35 MDOS/SGOPO |
| City | MISAWA AB |
| State | AP |
| Zip Code | 96319 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518510528 | Jeffrey Alan Utz | Military Health Care Provider | 35 Mdg Misawa, Misawa, AOMORI 96319 | 2019-07-18 |
| 1255828117 | Mary Joy Flores Orias | Counselor | Misawa Ab, Apo, AP 96319 | 2018-04-17 |
| 1124481742 | Esther Kehinde Ikotun | Social Worker | Psc76, Box8582, Apo, AP 96319 | 2016-03-31 |
| 1619101375 | Karl Elliott Vanover | Military Health Care Provider | 35 Mdg/sgpf, Unit 5041, Apo, AP 96319 | 2009-05-11 |
| 1619101870 | John Michael Cronin | Military Health Care Provider | 35 Mdg, Misawa Ab, Japan, Apo, AP 96319 | 2009-05-04 |
| 1063692135 | Eric C Parkinson | Pediatrics | 35 Mdg Building 99, Apo, AP 96319 | 2007-11-06 |
| 1972794634 | Daniel Stefan Micsunescu | Obstetrics & Gynecology | 35th Medical Group, Misawa Air Base, Bldg 99, Unit 5024, Apo, AP 96319 | 2007-08-07 |
| 1427265701 | Sharon H Proctor | Marriage & Family Therapist | Psc 76 Box 3974, Apo, AP 96319 | 2007-05-17 |
| 1073619656 | Laura Jean Ryan | Social Worker | Unit 5024, Apo, AP 96319 | 2006-09-15 |
| 1649291139 | James Albert Dombrowski | Orthopaedic Surgery | Psc 76, Box 6735, Apo, AP 96319 | 2006-07-21 |
| Find all providers in zip 96319 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689002545 | Amber Chew | Obstetrics & Gynecology | 549th Hc/bdaach, Unit 15245, Apo, AP 96271 | 2013-10-30 |
| 1174881601 | Mario Alejandro Macias II | Obstetrics & Gynecology | 3581 Roger Brooke Dr., Brooke Army Medical Center, Apo, AP 78234 | 2012-05-03 |
| 1972794634 | Daniel Stefan Micsunescu | Obstetrics & Gynecology | 35th Medical Group, Misawa Air Base, Bldg 99, Unit 5024, Apo, AP 96319 | 2007-08-07 |
| 1689708588 | Wendy Irelan Conway | Obstetrics & Gynecology | 374 Mdg/sgopo, Unit 5071, Apo, AP 96328 | 2007-03-15 |
| 1063421014 | Robert Gerald Fowers II | Obstetrics & Gynecology | Hhc 121st Gen Hos, Box #111, Apo, AP 96205-0177 | 2006-08-07 |
| 1801875968 | Susan Lynne Chittum | Obstetrics & Gynecology | Psc 482 Box 244, Fpo, AP 96362 | 2006-01-17 |
| 1689653735 | Elizabeth M. Adriano | Obstetrics & Gynecology | Usnh Guam--obgyn Dept, Psc 490 Box 9025, Fpo, AP 96538 | 2006-01-16 |
| 1629055280 | Fernando Moreno Jr. | Obstetrics & Gynecology | U. S. Naval Hospital Okinawa, Psc 482 Box 2490, Fpo, AP 96362-2490 | 2005-12-27 |
| 1952751174 | Kalen Hubbs | Obstetrics & Gynecology | 549 Hc/baach, Unit 15245, Apo, AP 96271 | 2016-06-18 |
| 1407215825 | Edward Joseph Houston | Obstetrics & Gynecology | 549 Hc/baach, Unit 15245, Apo, AP 96271 | 2016-02-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.