Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jack T Peterson Jr., MD

Individual provider Specialist · NPI 1508860487

Dr. Jack T Peterson Jr., MD is a Plastic and Reconstructive Surgery in Topeka, Kansas. Graduated from Baylor College of Medicine in 1983, 43 years ago. Practices as a sole proprietor. Licensed in Kansas.

Years since qualifying
43
Trained at
Baylor College of Medicine
Licensed in
KS
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

631 SW Horne St Ste 400
Topeka, KS 66606-1661
Phone: (785) 234-9000
Fax: (785) 234-9119
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 0422259 (KS)

Record details

NPI number1508860487
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 9, 2005
Last updated in NPPESApril 24, 2012

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPLASTIC AND RECONSTRUCTIVE SURGERY
Medical schoolBAYLOR COLLEGE OF MEDICINE
Graduated 1983 (43 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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