Individual
MR. MARC R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1515 S PHILLIPS ST, ALGONA, IA 50511-3649
(515) 295-7714
(515) 295-4505
Mailing address
1515 S PHILLIPS ST, ALGONA, IA 50511-3649
(515) 295-7714
(515) 295-4505
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000846
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36656
WELLMARK
IA
01
—
51939
WELLMARK
IA
Enumeration date
11/06/2006
Last updated
07/09/2007
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