Individual
GRANT E PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2515 SW STATE ST, STE 100, ANKENY, IA 50023-7079
(515) 964-6929
Mailing address
2515 SW STATE ST, STE 100, ANKENY, IA 50023-7079
(515) 964-6929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
6336
NE
207R00000X
Internal Medicine Physician
Primary
MD-41575
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881905370
—
IA
01
—
P01353680
RR MEDICARE
IA
Enumeration date
06/29/2010
Last updated
10/13/2014
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