Peterson, Mark G
Peterson, Mark G is an individual health care provider with primary practice located at 2650 32Nd Ave S Ste D , Grand Forks ND 58201-6541. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Peterson, Mark G can be contacted via phone (701) 732-2700.Contact Information
Primary practice address
2650 32Nd Ave S Ste D
Grand Forks ND 58201-6541
Phone: (701) 732-2700
Fax: (701) 732-2701
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 7376 | North Dakota |
Profile Details
| NPI number | 1134182355 |
|---|---|
| LBN Legal business name | Peterson, Mark G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 10th, 2006 |
| Last updated | Jan 3rd, 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 | 1134182355 | NPPES |
| North Dakota | MEDICAID | 18675 | |
| North Dakota | MEDICAID | 453615100 | |
| North Dakota | Other | 26183 | |
| North Dakota | Other | 244P5PE |
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