James D Petersen, MD | |
465 Memorial Dr, Pocatello, ID 83201-4008 | |
(208) 234-4700 | |
Not Available |
Full Name | James D Petersen |
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Gender | Male |
Speciality | Family Medicine |
Location | 465 Memorial Dr, Pocatello, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1437724432 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | MRM-2027 (Idaho) | Primary |
Entity Name | Syringa General Hospital District Cif |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1750336608 PECOS PAC ID: 6800707530 Enrollment ID: O20041008000778 |
Entity Name | Caribou Medical Center, Inc |
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Entity Type | Part A Provider - Critical Access Hospital |
Entity Identifiers | NPI Number: 1942970272 PECOS PAC ID: 7618365701 Enrollment ID: O20211021002404 |
Mailing Address | Practice Location Address |
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James D Petersen, MD 500 S 11th Ave Ste 400, Pocatello, ID 83201-4880 Ph: () - | James D Petersen, MD 465 Memorial Dr, Pocatello, ID 83201-4008 Ph: (208) 234-4700 |
Shayna Larae Harding, APRN Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1133 Call Creek Dr # A, Pocatello, ID 83201 Phone: 208-232-1000 Fax: 208-232-1006 | |
Cody E Patterson, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 151 N 4th Ave, Pocatello, ID 83201 Phone: 208-269-7147 Fax: 208-416-6522 | |
Dr. Bradley Yamashita Beaufort, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 465 Memorial Dr, Pocatello, ID 83201 Phone: 208-282-4700 Fax: 208-282-4696 | |
Ryan Hudgens, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 465 Memorial Dr, Pocatello, ID 83201 Phone: 208-232-7862 | |
Shaylor Bringhurst, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 465 Memorial Dr, Pocatello, ID 83201 Phone: 208-232-7862 | |
Dr. Sharla Clark, D.O. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1951 Bench Road, Suite B, Pocatello, ID 83201 Phone: 208-238-1000 Fax: 208-238-0009 | |
Marie Elwood, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 465 Memorial Dr, Pocatello, ID 83201 Phone: 208-232-7862 |