Individual
DR. GERALD DUDLEY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1880 WILLAMETTE FALLS DR, SUITE 111, WEST LINN, OR 97068-4652
(503) 657-1900
(503) 657-7744
Mailing address
1880 WILLAMETTE FALLS DR, SUITE 111, WEST LINN, OR 97068-4652
(503) 657-1900
(503) 657-7744
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
118
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168161
—
OR
01
—
930743342
BCBS OF OREGON
OR
Enumeration date
06/22/2006
Last updated
08/29/2011
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