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Individual
DR. MARK G PETERSON
Active
Individual
DR. MARK G PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7376
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18675
—
ND
01
—
244P5PE
BCBS OF MN
MN
01
—
26183
BCBS OF ND
ND
05
—
453615100
—
MN
Enumeration date
04/10/2006
Last updated
01/03/2020
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