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Individual
RANDY J PETERSON
Active
Individual
RANDY J PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
32212
MN
207Q00000X
Family Medicine Physician
Primary
32212
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0104802
MEDICA
MN
01
—
1006215
PREFERRED ONE
MN
01
—
107120D277
UCARE
MN
01
—
21468
AMERICA'S PPO
MN
01
—
33Y08PE
BLUE SHIELD
MN
05
—
687892000
—
MN
01
—
A006
CHAMPUS
MN
01
—
HP27225
HEALTH PARTNERS
MN
Enumeration date
01/23/2006
Last updated
01/17/2014
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