Peterson, Gary M
Peterson, Gary M is an individual health care provider with primary practice located at 4702 Grand Ave , Duluth MN 55807-2742. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Peterson, Gary M can be contacted via phone (218) 249-6800.Contact Information
Primary practice address
4702 Grand Ave
Duluth MN 55807-2742
Phone: (218) 249-6800
Fax: (218) 249-6808
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 28567 | Minnesota |
Profile Details
| NPI number | 1699724955 |
|---|---|
| LBN Legal business name | Peterson, Gary M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 6th, 2006 |
| Last updated | Dec 4th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699724955 | NPPES |
| Minnesota | MEDICAID | 611373700 |
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