Individual
DR. JEFFERY LEE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 W BROAD AVE, FLANDREAU, SD 57028-1529
(605) 997-2642
(605) 997-9940
Mailing address
1027 LAWRENCE CIR, SARTELL, MN 56377-2081
(605) 997-2642
(605) 997-9940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1067
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5546010
—
SD
Enumeration date
01/12/2007
Last updated
07/08/2007
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