NPI age
19 years
Enumerated 2006-11-29
● Active
Type 1 · Individual
DR. Joseph R Petersen
Petersen is 1 of 5 specialist providers in Burley and 1 of 305 in Idaho.
Primary specialty
Specialist
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2007-07-09
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 305 active specialist providers in Idaho.
NPI age
19 years
≈ at median (18 yr)
State licenses
1 state
2% of peers hold multiple states
Subspecialties
0
11% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-11Enumerated in NPPES
2006
2026
Where they practice
Practice location
1344 Hiland Ave Ste A
Burley, ID 833181564
Mailing address
1344 Hiland Ave Ste A, P. O. Box 1263
Burley, ID 833181564
Specialties
-
Specialist PrimaryAn 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.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010003563 | BLUE SHIELD PROVIDER NO. |
| 01 (ID) | C36979 | DMBA |
| 01 (ID) | 014917 | SELECTCARE |
| 01 (ID) | I000490 | TRICARE |
| 01 (ID) | 74096 | BLUE CROSS PROVIDER NUMBE |
| 01 (ID) | 0791870001 | MEDICARE DMERC |
Practice context
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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