Individual
DOUGLAS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 E BROADWAY AVE, BISMARCK, ND 58501-4520
(701) 530-7000
Mailing address
PO BOX 997, BISMARCK, ND 58502-0997
(701) 530-7000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5206
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452800
—
ND
01
—
P00441490
RAILROAD MEDICARE
ND
Enumeration date
06/27/2006
Last updated
07/22/2016
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