Provider Demographics
NPI:1487949657
Name:DARRYL W. PETERSON
Entity type:Organization
Organization Name:DARRYL W. PETERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-454-6000
Mailing Address - Street 1:7855 HOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807
Mailing Address - Country:US
Mailing Address - Phone:225-454-6000
Mailing Address - Fax:225-454-6016
Practice Address - Street 1:7855 HOWELL PLACE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5256
Practice Address - Country:US
Practice Address - Phone:225-454-6000
Practice Address - Fax:225-454-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012182R284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital