Provider Demographics
NPI:1447255245
Name:PETERSON, GREGORY E (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1510 PLEASANT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-2126
Mailing Address - Country:US
Mailing Address - Phone:515-771-2527
Mailing Address - Fax:855-642-1942
Practice Address - Street 1:1510 PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-2126
Practice Address - Country:US
Practice Address - Phone:515-771-2527
Practice Address - Fax:855-642-1942
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA01984207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0237933Medicaid
IA03214Medicare ID - Type Unspecified
IA0237933Medicaid