MAVERICK LEE PETERSON
NPI 1346028149
Military Health Care Provider - Independent Duty Medical Technicians in Cannon Afb, NM

Active since September 21, 2023
224 W D. L. INGRAM AVENUE, BLDG. 1408, CANNON AFB, NM 88103(715) 817-6949 Get Directions Write a Review

NPPES record last updated: February 2, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Maverick Lee Peterson NPPES

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

MAVERICK LEE PETERSON (NPI 1346028149) is an individual independent duty medical technicians provider in Cannon Afb, New Mexico and active in the NPI registry since September 2023.

NPPES Registry Identity

NPI1346028149
Entity TypeIndividualMale
Primary Taxonomy1710I1003X
Provider Legal NameMAVERICK LEE PETERSON
Location Address224 W D. L. INGRAM AVENUE, BLDG. 1408Cannon Afb, NM 88103
Mailing Address224 W D. L. Ingram Avenue, Bldg. 1408Cannon Afb, NM 88103
Sole ProprietorNo
Enumeration DateSeptember 21, 2023
Last NPPES UpdateFebruary 2, 2024
NPPES CertifiedJanuary 31, 2024
NPI 1346028149 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code1710I1003X
Definition
An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians.
224 W D. L. INGRAM AVENUE, BLDG. 1408, Cannon Afb, NM 88103

Other Providers at the Same Location NPPES 11

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

Social Worker (Clinical)
224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB, NM 88103
Counselor (Professional)
224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB, NM 88103
Social Worker (Clinical)
224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB, NM 88103
Optometrist
224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB, NM 88103
Physical Therapist (Orthopedic)
224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB, NM 88103
Family Medicine
224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB, NM 88103
Registered Nurse
224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB, NM 88103
Military Health Care Provider (Independent Duty Medical Technicians)
224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB, NM 88103

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 Maverick Peterson's NPI number?

The NPI number for Maverick Peterson is 1346028149. It was assigned to this individual provider in the NPPES registry on September 21, 2023.

Where is Maverick Peterson located?

Maverick Peterson practices at 224 W D. L. Ingram Avenue, Bldg. 1408, Cannon Afb, NM 88103. The listed phone number is (715) 817-6949.

What is Maverick Peterson's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Medical Technicians, with taxonomy code 1710I1003X.

When was this NPI record last updated?

The NPPES record for Maverick Peterson was last updated on February 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.