Individual
MR. GARY M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4702 GRAND AVE, DULUTH, MN 55807-2742
(218) 249-6800
(218) 249-6808
Mailing address
4702 GRAND AVE, DULUTH, MN 55807-2742
(218) 249-6800
(218) 249-6808
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28567
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
611373700
—
MN
Enumeration date
05/06/2006
Last updated
12/04/2020
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