Provider Demographics
NPI:1932402351
Name:PETERSON, RYAN L (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:ONE BOONE ROAD
Mailing Address - Street 2:NAVAL HOSPITAL
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1898
Mailing Address - Country:US
Mailing Address - Phone:425-304-4142
Mailing Address - Fax:425-304-4126
Practice Address - Street 1:60000 HIGHWAY 98
Practice Address - Street 2:NAVAL HOSPITAL
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0003
Practice Address - Country:US
Practice Address - Phone:850-505-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2024-05-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant