NPI 1366870206

Jedidiah Allen Petersen, PA

Practitioner Physician Assistant Polson, MT

Practice location

Address: 6 13th Ave E, Polson, MT 59860-5315
Phone: (406) 883-5680
Fax: (406) 883-8960
Mailing address: PO Box 262, Liberty Lake, WA 99019-0262

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence PA-1110 (ID)

Other Physician Assistant providers in Montana →

Registry record

NPI: 1366870206
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Oct 2013
Record last updated: 8 Dec 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.