# DR. RANDOLPH K. PETERSON

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1053380204
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 40788 | MN | Yes |

## Other

- **Enumeration date:** 03/17/2006
- **Last updated:** 11/10/2015

## 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 |