Individual
DR. RONALD J. PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 NICOLLET MALL, SUITE 400, MINNEAPOLIS, MN 55402-2500
(612) 333-2503
Mailing address
801 NICOLLET MALL, SUITE 400, MINNEAPOLIS, MN 55402-2500
(612) 333-2503
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
23275
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0700065
MEDICA DUAL/MEDICARE MA
MN
01
—
0701452
MEDICA
MN
01
—
13724PE
BLUE CROSS BLUE SHIELD
MN
01
—
26399
AMERICA'S PPO
MN
05
—
30400000
—
WI
01
—
A004
TRICARE WEST/CHAMPUS
MN
01
—
FP9041001070
PREFERRED ONE
MN
01
—
HP14163
HEALTH PARTNERS
MN
Enumeration date
05/13/2006
Last updated
07/08/2007
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