MR. DAVID ANDREW PETERSON JR. (NPI# 1639147606) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639147606 |
| Entity Type | Individual |
| Full Name | MR. DAVID ANDREW PETERSON JR. |
| Practice Address |
Nomi Det Numi Submarine Base Nlon Building 159 Groton CT 06349 |
| Mailing Address |
125 Hickory St Norwich CT 06360-4634 |
| Practice Telephone | 8606942876 |
| Practice Fax Number | 8606943874 |
| Mailing Telephone | 8605145293 |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| INDEPENDENT DUTY CORPSMAN | 1710I1002X | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215410584 | David Peterson | Dentist | 1619 Brandywine Ln, Dixon, IL 61021-8757 | 2018-09-12 |
| 1386070647 | David Michael Peterson | Pharmacist | 1200 W Gold St, Butte, MT 59701-2110 | 2013-09-18 |
| 1427336601 | David James Peterson | Physical Therapist | 59 Akea Pl, Kula, HI 96790-8501 | 2011-07-22 |
| 1386858942 | David Brian Peterson | Psychologist | 460 Oak St, Apt 115, Glendale, CA 91204-1265 | 2007-05-10 |
| 1851412241 | David Peterson | Chiropractor | 17331 Penn Valley Dr, Penn Valley, CA 95946-9340 | 2007-04-03 |
| 1487716783 | David Norman Peterson | Dentist | 22 2nd Ave S, Sauk Rapids, MN 56379-1408 | 2006-12-14 |
| 1033279484 | David Eugene Peterson | Dentist | 17267 W 3rd St, Sddc, Redfield, SD 57469-1001 | 2006-12-08 |
| 1801968359 | David Scott Peterson | Psychiatry & Neurology | 1345 East 3900 South Ste 208, Salt Lake City, UT 84124-4416 | 2006-11-13 |
| 1104905272 | David Hedden Peterson | Social Worker | 222 9th Ave W, Alexandria, MN 56308-2221 | 2006-11-02 |
| 1932284031 | David Donald Peterson | Counselor | 318 E Main St # 106, Battle Ground, WA 98604-8508 | 2006-10-26 |
| Street Address |
NOMI DET NUMI SUBMARINE BASE NLON BUILDING 159 |
| City | GROTON |
| State | CT |
| Zip Code | 06349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205434347 | Mvca | Optometrist | Navy Submarine Base New London, Bldg 484, Groton, CT 06349 | 2020-10-12 |
| 1376194274 | Christopher Lee Roy Smith | Military Health Care Provider | Uss San Juan (ssn 751), Groton, CT 06349 | 2019-09-23 |
| 1588127575 | Morgan Ross Jones | Student in an Organized Health Care Education/Training Program | Bx 159 Navsubase Nlon, Groton, CT 06349 | 2019-04-08 |
| 1689179640 | David Saunders | Military Health Care Provider | 159 Navsubase Nlon, Groton, CT 06349 | 2018-03-29 |
| 1013264423 | Dennis Buenaventura Custodio | Military Health Care Provider | 69 Trout Ave, Naval Undersea Medical Institute, Groton, CT 06349 | 2012-08-06 |
| 1609013549 | Nicolas David Mendoza | Military Health Care Provider | Uss Hawaii (ssn 776), Fpo, AE 06349 | 2009-01-14 |
| 1881843084 | Mark Francis Jarvis | Military Health Care Provider | Nssc Nlon, Bldg 76, Groton, CT 06349 | 2008-09-11 |
| 1780882738 | Michael Nutt | Military Health Care Provider | Bldg 517 Taugtog Ave, Navsubscol, Groton, CT 06349 | 2007-07-10 |
| 1497811343 | Keith Benjamin Hoekman | Nurse Practitioner | 1 Wahoo Dr, Groton, CT 06349 | 2006-12-28 |
| 1881604163 | Christina E Toufexis | Pediatrics | 1 Wahoo Drive, Groton, CT 06349 | 2006-08-09 |
| Find all providers in zip 06349 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063052819 | Kenny Daniel Harp | Military Health Care Provider | 59 Deerwood Dr, Groton, CT 06340-2513 | 2020-01-09 |
| 1982244737 | Lonnie Jay Reardon | Military Health Care Provider | 55 South Rd Apt 12c, Groton, CT 06340-4660 | 2020-01-09 |
| 1376194274 | Christopher Lee Roy Smith | Military Health Care Provider | Uss San Juan (ssn 751), Groton, CT 06349 | 2019-09-23 |
| 1679132112 | Hector Salvador Gonzalez | Military Health Care Provider | 2 Bushnell St, Groton, CT 06340-3306 | 2019-06-09 |
| 1295393692 | Ermelinda Elaine Alviso | Military Health Care Provider | Trout Ave, Groton, CT 06340 | 2019-05-31 |
| 1558929026 | Joshua Darren Savage | Military Health Care Provider | 35 Chrissos St, Groton, CT 06340-3307 | 2019-05-30 |
| 1679034011 | Derek James Hale | Military Health Care Provider | Fc 83 Numi, Trout Ave, Groton, CT 06340 | 2019-03-28 |
| 1063973790 | Cody Eugene Shaw | Military Health Care Provider | Numi, Trout Ave Building 83, Groton, CT 06340 | 2019-03-26 |
| 1689179640 | David Saunders | Military Health Care Provider | 159 Navsubase Nlon, Groton, CT 06349 | 2018-03-29 |
| 1992241228 | Phillip Lawernce Hardy Sr. | Military Health Care Provider | 123 Trout Ave, Naval Undersea Medical Institiute, Groton, CT 06340-5159 | 2017-01-10 |
| Find all providers in GROTON | ||||
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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.