Individual
DALE M. PETERSON
Active
Individual
DALE M. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
3859
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011815
MDCD PIN
MT
01
—
307893
BCBS PIN
WY
Enumeration date
09/24/2006
Last updated
02/28/2008
Update your record
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