Provider Demographics
NPI:1043270119
Name:PETERSON, GERALD FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:FREDERICK
Last Name:PETERSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:1400 CORPORATE CENTER CURV STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1372
Practice Address - Country:US
Practice Address - Phone:519-685-3006
Practice Address - Fax:651-646-0205
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN23624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E26990Medicare UPIN