Individual
DAVID C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
323 S MINNESOTA ST, CROOKSTON, MN 56716-1601
(218) 281-9556
Mailing address
11823 MAPLE LAKE DR SE, MENTOR, MN 56736-9443
(218) 574-2220
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
301
MN
213ES0131X
Foot Surgery Podiatrist
301
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0921200001
DMERC
—
01
—
26801
BCBS
ND
01
—
597S9PE
BCBS MN
MN
Enumeration date
10/31/2006
Last updated
01/08/2008
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