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Individual

DR. PAUL CHARLES PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2735
(320) 255-7891
(320) 255-5882
Mailing address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2736
(320) 255-7891

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
200300395
NC
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
200300395
NC
2084V0102X
Vascular Neurology Physician
200300395
NC
2084V0102X
Vascular Neurology Physician
Primary
64851
MN

Other

Enumeration date
07/15/2005
Last updated
04/23/2020
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