Provider Demographics
NPI:1487977252
Name:PETERSON, BRAXTON EARL (BS, AS)
Entity type:Individual
Prefix:MR
First Name:BRAXTON
Middle Name:EARL
Last Name:PETERSON
Suffix:
Gender:M
Credentials:BS, AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 HWY 125
Mailing Address - Street 2:
Mailing Address - City:OAK CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27857-9998
Mailing Address - Country:US
Mailing Address - Phone:252-802-1683
Mailing Address - Fax:
Practice Address - Street 1:107 N ELM ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2301
Practice Address - Country:US
Practice Address - Phone:252-802-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health