ALAN C PETERSON (NPI# 1477555225) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477555225 |
| Entity Type | Individual |
| Full Name | ALAN C PETERSON |
| Credential | M.D. |
| Practice Address |
7910 W Jefferson Blvd Suite 102 Fort Wayne IN 46804-4159 |
| Mailing Address |
6920 Pointe Inverness Way Ste 200 Fort Wayne IN 46804-7934 |
| Practice Telephone | 2604322297 |
| Practice Fax Number | 2604346420 |
| Mailing Telephone | 2604793514 |
| Mailing Fax Number | 2604793520 |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2020-09-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 01031812A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | RR MEDICARE | 330005240 | 01 |
| MI | 2907251 | 05 | |
| OH | 0518649 | 05 | |
| IN | 100096130 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538282769 | Alan Lee Peterson | Psychologist | 7550 W Ih 10, Suite 1325, San Antonio, TX 78229-5803 | 2007-04-10 |
| 1699713495 | Alan Peterson | Family Medicine | 317 S Chestnut St, Quarryville, PA 17566-1344 | 2006-06-03 |
| 1174975429 | Alan Clark Peterson Sr. | Dentist | 601 Mcdonough Blvd Se, Atlanta, GA 30315-4400 | 2016-07-11 |
| 1265691653 | Alan C Peterson | Anesthesiology | 11600 W 2nd Pl, Lakewood, CO 80228-1527 | 2008-06-02 |
| 1154484657 | Alan Lee Peterson | Internal Medicine | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-12-18 |
| 1750443131 | Alan Gunnar Peterson | Physician Assistant | 1600 Eureka Rd, Roseville, CA 95661-3027 | 2006-12-14 |
| 1275649683 | Alan Peter Peterson | Pathology | 320 Willow St, Walla Walla, WA 99362 | 2006-08-21 |
| 1992751325 | Alan Clifton Peterson | Pathology | 415 6th St, Lewiston, ID 83501-2431 | 2006-05-26 |
| 1720048978 | Alan C Peterson Jr. | Internal Medicine | 1750 Laurel Street, Columbia, SC 29201 | 2006-03-23 |
| Street Address |
7910 W JEFFERSON BLVD SUITE 102 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-4159 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548264963 | Gregory W Veerkamp | Pediatrics | 7910 W Jefferson Blvd, Ste 201, Fort Wayne, IN 46804-4159 | 2005-06-13 |
| 1093171829 | Leann E. Guerra | Nurse Practitioner | 7910 W Jefferson Blvd, Suite 112, Fort Wayne, IN 46804-4159 | 2016-01-09 |
| 1649651043 | Christel L. Hayes | Nurse Practitioner | 7910 W Jefferson Blvd, Suite 109b, Fort Wayne, IN 46804-4159 | 2015-06-11 |
| 1467842344 | Marena A. Arnold | Nurse Practitioner | 7910 W Jefferson Blvd, Suite 120, Fort Wayne, IN 46804-4159 | 2015-01-29 |
| 1740689207 | Associated Surgeons & Physicians, LLC | Colon & Rectal Surgery | 7910 W Jefferson Blvd, Suite 305, Fort Wayne, IN 46804-4159 | 2014-08-20 |
| 1407292287 | Brittany S Knox | Registered Nurse | 7910 W Jefferson Blvd, Suite 300, Fort Wayne, IN 46804-4159 | 2013-05-20 |
| 1417256702 | Johnell J Treesh-valentine | Nurse Practitioner | 7910 W Jefferson Blvd, Medical Office Building 2, Suite 200, Fort Wayne, IN 46804-4159 | 2011-03-25 |
| 1619203692 | Joel F. Nagel | Nurse Practitioner | 7910 W Jefferson Blvd, Suite 112, Fort Wayne, IN 46804-4159 | 2009-10-26 |
| 1639313158 | Margaret Ann Rodenbeck | Registered Nurse | 7910 W Jefferson Blvd, Fort Wayne, IN 46804-4159 | 2009-04-28 |
| 1912152125 | Rachael R. Hayes | Surgery | 7910 W Jefferson Blvd, Suite 109b, Fort Wayne, IN 46804-4159 | 2008-12-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114122488 | Hannah Copeland | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 7910 W Jefferson Blvd Ste 102, Fort Wayne, IN 46804-4159 | 2007-06-18 |
| 1356544308 | Melmar LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2410 N Glendale Dr, Suite C, Fort Wayne, IN 46804-8908 | 2007-06-07 |
| 1578655494 | Marcus A Jimenez | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2510 N Glendale Drive, Suite C, Fort Wayne, IN 46804 | 2006-09-28 |
| 1639171499 | John R Stanford | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2414 E State Blvd, Carew Building #1, Suite 201, Fort Wayne, IN 46805-4760 | 2005-08-11 |
| 1154616175 | Tariq Omar Lescouflair | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 11108 Parkview Circle Dr Ste 5100, Fort Wayne, IN 46845 | 2011-06-17 |
| 1699975342 | Christopher J. Gullett | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 7910 W Jefferson Blvd Ste 102, Fort Wayne, IN 46804-4159 | 2007-07-20 |
| 1205989159 | Fort Wayne Cardiovascular Associates | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 11123 Parkview Plaza Dr, Suite 202, Fort Wayne, IN 46845-1707 | 2007-01-22 |
| 1215080692 | Fort Wayne Cardiovascular Associates | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 800 Broadway, Suite 201, Fort Wayne, IN 46802-2149 | 2007-01-19 |
| 1790718765 | Fort Wayne Cardiovascular Surgeon | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 11123 Parkview Plaza Dr, Suite 202, Fort Wayne, IN 46845-1707 | 2006-07-10 |
| 1679551741 | Fort Wayne Cardiovascular Surgeons, PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1818 Carew St, Suite 250, Fort Wayne, IN 46805-4788 | 2006-01-09 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.