Individual
DOUGLAS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1630 ANDERSON AVE, BUFFALO, MN 55313-2945
(800) 876-7171
Mailing address
5008 QUEEN AVE S, MINNEAPOLIS, MN 55410-2207
(612) 929-0298
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
22930
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146290300
—
MN
01
—
92M48PE
BCBS
MN
05
—
92M48PE
—
MN
Enumeration date
12/13/2005
Last updated
07/09/2007
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