Individual
TERRY A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2601 BROADWAY N, FARGO, ND 58102-6704
(701) 234-2900
(701) 234-2996
Mailing address
2601 BROADWAY N, FARGO, ND 58102-6704
(701) 234-2900
(701) 234-2996
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0208
ND
363AM0700X
Medical Physician Assistant
9599
MN
363AM0700X
Medical Physician Assistant
PAC0208
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71084
—
ND
Enumeration date
07/18/2006
Last updated
04/18/2016
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