Individual
RANDY J PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1527 BROADWAY ST, ALEXANDRIA, MN 56308-2537
(320) 762-0399
(320) 762-6847
Mailing address
1527 BROADWAY ST, ALEXANDRIA, MN 56308-2537
(320) 762-0399
(320) 762-6847
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
32212
MN
207Q00000X
Family Medicine Physician
Primary
32212
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0104802
MEDICA
MN
01
—
1006215
PREFERRED ONE
MN
01
—
107120D277
UCARE
MN
01
—
21468
AMERICA'S PPO
MN
01
—
33Y08PE
BLUE SHIELD
MN
05
—
687892000
—
MN
01
—
A006
CHAMPUS
MN
01
—
HP27225
HEALTH PARTNERS
MN
Enumeration date
01/23/2006
Last updated
01/17/2014
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