# DR. MARK G 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:** 1134182355
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 7376 | ND | Yes |

## Other

- **Enumeration date:** 04/10/2006
- **Last updated:** 01/03/2020

## 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 |