Provider Demographics
NPI:1194043513
Name:PETERSON, BETH (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-577-6000
Mailing Address - Fax:903-577-6245
Practice Address - Street 1:2001 N JEFFERSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2310
Practice Address - Country:US
Practice Address - Phone:903-434-8880
Practice Address - Fax:903-434-8881
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2862208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery