Individual
KENT JOHN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(801) 234-2000
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(701) 234-2000
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
22778
ND
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/08/2018
Last updated
01/28/2026
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