JOHN J PETERSEN (NPI# 1164580429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164580429 |
| Entity Type | Individual |
| Full Name | JOHN J PETERSEN |
| Credential | PA |
| Practice Address |
520 Medical Center Dr Suite 201 Medford OR 97504-4334 |
| Mailing Address |
2620 E Barnett Rd Suite H Medford OR 97504-8344 |
| Practice Telephone | 5417895710 |
| Mailing Telephone | 5417895250 |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2013-01-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA00228 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500613512 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962646224 | John Thomas Petersen | Registered Nurse | 1901 Medi Park Dr Ste 2051, Amarillo, TX 79106-2169 | 2009-04-29 |
| 1497973630 | John Robert Petersen | Chiropractor | 2216 County Road D W, Saint Paul, MN 55112-7500 | 2007-04-23 |
| 1720110737 | John William Petersen | Chiropractor | 12000 Elm Creek Blvd N Ste L70, Maple Grove, MN 55369-7167 | 2007-03-12 |
| 1851491526 | John Anthony Petersen | Psychologist | 922 E Wayne St # 205, South Bend, IN 46617-3024 | 2006-09-23 |
| 1790786895 | John Peter Petersen | Radiology | 3555 10th Court, Indian River Regional Cancer Center, Irmc, Vero Beach, FL 32960-4862 | 2005-08-10 |
| 1508422411 | John Robert Petersen | Dentist | 4555 Erin Dr, Eagan, MN 55122-3398 | 2019-05-15 |
| 1619361805 | John Devin Petersen | Pediatrics | 757 Westwood Plz, B711 Rrumc, Los Angeles, CA 90095-7419 | 2015-03-25 |
| 1841587854 | John Roger Petersen | Pathology | 301 University Blvd, Galveston, TX 77555-0551 | 2011-06-29 |
| 1114167434 | John Seigfred Petersen | Dentist | 415 Central Ave, Whitefish, MT 59937-2770 | 2009-02-26 |
| 1588868939 | John William Petersen | Internal Medicine | 1600 Sw Archer Rd, Gainesville, FL 32610-3003 | 2007-06-11 |
| Street Address |
520 MEDICAL CENTER DR SUITE 201 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-4334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922095199 | Joel A Tobias | Internal Medicine | 520 Medical Center Dr, Suite 200, Medford, OR 97504-4314 | 2005-10-04 |
| 1033588546 | Daniel Neville | Physician Assistant | 520 Medical Center Dr, Suite 201, Medford, OR 97504-4334 | 2015-09-15 |
| 1063855161 | App Cardiovascular Surgeons | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 520 Medical Center Dr, Suite 201, Medford, OR 97504-4334 | 2013-04-09 |
| 1205180098 | Stephani Kathleen Cook | Physician Assistant | 520 Medical Center Dr, Suite 300, Medford, OR 97504-4334 | 2012-11-01 |
| 1790014074 | Christopher Charles Davis | Physician Assistant | 520 Medical Center Dr, Suite 300, Medford, OR 97504-4334 | 2009-12-15 |
| 1033444781 | Southern Oregon Cardiology LLC | Internal Medicine | 520 Medical Center Dr, Ste 200, Medford, OR 97504-4314 | 2009-10-14 |
| 1104056092 | Dani J Thomas | Internal Medicine | 520 Medical Center Dr, Suite 2001, Medford, OR 97504-4334 | 2009-07-26 |
| 1265675599 | Natalie E Baxter | Physician Assistant | 520 Medical Center Dr, Ste 300, Medford, OR 97504-4334 | 2009-04-16 |
| 1629267414 | Pamela Reeger Cortell | Nurse Practitioner | 520 Medical Center Dr, Ste 300, Medford, OR 97504-4316 | 2007-10-17 |
| 1144412529 | Patrick Joseph Phelan | Surgery | 520 Medical Center Dr, Ste 300, Medford, OR 97504-4316 | 2007-08-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154848356 | Alyssa Catherine Griffin | Physician Assistant | 265 Bridgeport Ave, Medford, NY 11763-4018 | 2017-08-28 |
| 1760907125 | Amanda Stevens | Physician Assistant | 1731 N Ocean Ave Ste A, Medford, NY 11763-2670 | 2017-08-07 |
| 1518366863 | Latoya Allen | Physician Assistant | 2450 Highgate St, Unit 12, Medford, OR 97501-7955 | 2014-08-21 |
| 1942491097 | Diana M Loo | Physician Assistant | 940 Royal Ave Unit 420, Medford, OR 97504-6194 | 2007-08-05 |
| 1821159658 | Dean W Moss | Physician Assistant | 3720 Fieldbrook Ave, Medford, OR 97504-9474 | 2006-12-13 |
| 1437762333 | Nicole Elisa Gregoire | Physician Assistant | 2900 State St, Medford, OR 97504-8458 | 2020-08-28 |
| 1043705460 | Hakan Binek | Physician Assistant | 520 Medical Center Dr Ste 300, Medford, OR 97504-4316 | 2018-06-27 |
| 1659884401 | Savana Marisa Cochrane | Physician Assistant | 520 Medical Center Dr Ste 300, Medford, OR 97504-4316 | 2017-11-14 |
| 1730692500 | Michael Jaskot | Physician Assistant | 2780 E Barnett Rd, Medford, OR 97504-8674 | 2017-11-14 |
| 1740792316 | James Zheng Berking | Physician Assistant | 2780 E Barnett Rd, Medford, OR 97504-8674 | 2017-11-03 |
| Find all providers in MEDFORD | ||||
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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.