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DR. JOSEPH R PETERSEN
NPI 1225105604
Specialist in Burley, ID

Active since November 29, 2006
1344 HILAND AVE STE A, BURLEY, ID 83318(208) 678-1138(208) 678-5833 Get Directions Write a Review

NPPES record last updated: July 9, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Joseph R Petersen NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JOSEPH R PETERSEN (NPI 1225105604) is an individual specialist in Burley, Idaho, licensed in Idaho (M5283) and active in the NPI registry since November 2006.

NPPES Registry Identity

NPI1225105604
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameDR. JOSEPH R PETERSEN
Location Address1344 HILAND AVE STE ABurley, ID 83318-1564
Mailing Address1344 Hiland Ave Ste A, P. O. Box 1263Burley, ID 83318-1564 · (208) 678-1138 · Fax (208) 678-5833
Phone(208) 678-1138
Fax(208) 678-5833
Sole ProprietorYes
Enumeration DateNovember 29, 2006
Last NPPES UpdateJuly 9, 2007
✔ NPI 1225105604 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in ID · M5283
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1344 HILAND AVE STE A, Burley, ID 83318
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Other Names 1

Professional Name (2)Dr. Joseph Petersen M.d.

Other Identifiers 9

Other0791870001ID · Medicare Dmerc
Other74096ID · Blue Cross Provider Numbe
Medicare UPINC36979ID
OtherI000490ID · Tricare
Medicare ID-Type Unspecified1374841ID · Medicare
Other000010003563ID · Blue Shield Provider No.
Other014917ID · Selectcare
OtherC36979ID · Dmba
Medicare ID-Type Unspecified1119681ID · Medicare Provider Number

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MAGIC VALLEY PAIN SPECIALISTS, PLLC
Anesthesiology (Pain Medicine)
1344 HILAND AVE STE A
BURLEY, ID 83318
Cassia County (208) 678-7246
TYLER ROE DO
Anesthesiology (Pain Medicine)
1344 HILAND AVE STE A
BURLEY, ID 83318
Cassia County (208) 678-7246
JOSEPH R. PETERSEN, M.D.
Specialist
1344 HILAND AVE STE A
BURLEY, ID 83318
Cassia County (208) 678-1138

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Joseph Petersen's NPI number?

The NPI number for Joseph Petersen is 1225105604. It was assigned to this individual provider in the NPPES registry on November 29, 2006. The provider is also known as Dr. Joseph Petersen M.D..

Where is Joseph Petersen located?

Joseph Petersen practices at 1344 Hiland Ave Ste A, Burley, ID 83318. The listed phone number is (208) 678-1138.

What is Joseph Petersen's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Joseph Petersen was last updated on July 9, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.