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Individual

DENNIS L PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1555 NORTHWAY DRIVE, SUITE 200, ST CLOUD, MN 56303-4913
(320) 240-3157
(320) 240-3143
Mailing address
1555 NORTHWAY DRIVE, SUITE 200, ST CLOUD, MN 56303-4913
(320) 240-3157
(320) 240-3143

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33856
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01-25185
MEDICA
MN
01
080049494
RR MEDICARE
MN
01
114462
UCARE
MN
05
118202100
MN
01
2F977PE
BLUE CROSS BLUE SHIELD
MN
01
325101845
PRIMEWEST
MN
01
764610
ARAZ
MN
01
HP21681
HEALTH PARTNERS
MN
01
MR1081007925
PREFERRED ONE
MN
Enumeration date
07/18/2006
Last updated
09/10/2013
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