Individual
DR. THOMAS MICHAEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4700 S WASHINGTON ST STE G, GRAND FORKS, ND 58201-8123
(701) 205-3000
(701) 732-2501
Mailing address
PO BOX 5210, GRAND FORKS, ND 58206-5210
(701) 205-3000
(701) 732-2501
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
6217
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12325
ND BC/BS
ND
05
—
1460891
—
ND
05
—
17392
—
ND
05
—
878583000
—
MN
Enumeration date
04/03/2006
Last updated
01/02/2020
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