Jonathan Peterson, M.D.
Individual provider Active NPI Geriatric Psychiatry Physician · Wabasha, MN
NPI 1003882010 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1003882010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Psychiatry Physician 2084P0805X
- License
- 33320 (MN)
- Practice address
- 1200 Grant Blvd W
Wabasha, MN 55981-1042 - Phone
- (651) 565-5908
- Fax
- (651) 565-5910
- NPI assigned
- Feb 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33320 | MN | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jonathan G. Peterson Psychiatry, LTD. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Psychiatry Physician | 2084P0805X | 33320 | MN | Yes |
Addresses
Primary practice location
1200 Grant Blvd W
Wabasha, MN 55981-1042
Mailing address
1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-5908
Other providers in Wabasha, MN
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- Ava Perry
- Isaac Perry
- Phillip G Perry
- Cheryl Phyle
- Ryan Randy Reidt
- Sharon Riester
- Brady Ritscher
- Fred McRae Roberson
All providers in Wabasha, MN · Geriatric Psychiatry Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.