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Individual
DR. RANDOLPH K. PETERSON
Active
Individual
DR. RANDOLPH K. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
40788
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-00306
MEDICA
MN
01
—
220033481
RAILROAD MEDICARE
MN
01
—
525S5PE
BLUE CROSS
MN
05
—
881029000
—
MN
01
—
984811017049
PREFERRED ONE
MN
01
—
HP31830
HEALTHPARTNERS
MN
Enumeration date
03/17/2006
Last updated
11/10/2015
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