Provider Demographics
NPI:1386056026
Name:PETERSON, REMONA (MD)
Entity type:Individual
Prefix:
First Name:REMONA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 HIGHWAY 69 S STE M
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-6498
Mailing Address - Country:US
Mailing Address - Phone:074-803-3906
Mailing Address - Fax:205-764-5187
Practice Address - Street 1:6521 HIGHWAY 69 S STE M
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405
Practice Address - Country:US
Practice Address - Phone:205-764-5162
Practice Address - Fax:205-764-5187
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36198207Q00000X
ALMD36198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine