Individual
RODNEY HOLMES PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3250 W 66TH ST, SUITE 100, EDINA, MN 55435-2528
(952) 920-0970
(952) 922-1605
Mailing address
6465 WAYZATA BLVD, SUITE 900, ST LOUIS PARK, MN 55426-1728
(952) 512-5600
(952) 512-5650
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
16752
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30298200
WISC MEDICAID
—
01
—
509S0PE
BLUECROSS BLUESHIELD
—
01
—
900732
MEDICA
—
01
—
969990831004
PREFERREDONE
—
01
—
HP14162
HEALTHPARTNERS
—
Enumeration date
08/15/2006
Last updated
07/11/2007
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