Individual
DR. GLORIA J PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3050 CENTRE POINT DRIVE, SUITE 200, ROSEVILLE, MN 55113
(651) 631-4242
(651) 631-4260
Mailing address
8170 33RD AVE S, BLOOMINGTON, MN 55425-4516
(651) 631-4242
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
32724
MN
207Q00000X
Family Medicine Physician
Primary
32724
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
634705300
—
MN
Enumeration date
07/11/2006
Last updated
01/30/2020
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