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Contact Information

JUSTIN R PETERSON, MD
15301 WARREN SHINGLE RD
ATTN: KEN WINN, CREDENTIAL COORDINATOR
BEALE AFB, CA95903
 Phone: 530-634-4662
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for JUSTIN R PETERSON · (Male)

NPI # 1174948012
Status Active
Credentials MD
Entity Individual
Enumeration date 03/01/2014
Last updated 09/04/2025 - About 9 months ago
Sole proprietor 1 No
Identifiers
  • CA License # 154828
  • VA License # 0101259916
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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