Individual ProviderBrendon D PetersonGeneral PracticeAllopathic & Osteopathic PhysiciansPractice Address34800 Bob Wilson Dr, San Diego, CA 92134-1098(619) 532-6499PECOS EnrollmentBased on the most recent information from CMS, provider Brendon D Peterson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1639846942Provider TypeIndividualFull NamePeterson, Brendon DCredentialMDGenderMaleSole ProprietorNoEnumeration Date8/24/2021Last Updated8/11/2025Contact InformationPractice LocationPractice Address34800 Bob Wilson Dr, San Diego, CA 92134-1098Phone(619) 532-6499FaxUnlisted FaxMailing LocationMailing Address34800 Bob Wilson Dr, San Diego, CA 92134-1098Phone(619) 532-6499FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208D00000XPrimaryDescriptionGeneral PracticeAllopathic & Osteopathic PhysiciansLicenseU5792Texas