Individual
DR. RANDOLPH K. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6525 FRANCE AVE S, SUITE 200, EDINA, MN 55435-2148
(952) 927-6501
(952) 653-1435
Mailing address
6525 FRANCE AVE S, SUITE 200, EDINA, MN 55435-2148
(952) 927-6501
(952) 653-1435
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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