Provider Demographics
NPI:1447252952
Name:PETERSEN, WILLIAM A (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1501 NW 49TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3723
Mailing Address - Country:US
Mailing Address - Phone:954-714-6351
Mailing Address - Fax:919-425-0478
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:SUITE 323 WEST WING
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5110
Practice Address - Fax:919-425-0478
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME92846207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272273900Medicaid
FL272273900Medicaid
FL03480ZMedicare PIN