Marc R Peterson, PA

Key facts

NPI

1083783237

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

000846 (IA)

Practice address

1515 S Phillips St
Algona, IA 50511-3649

Phone

(515) 295-7714

Fax

(515) 295-4505

NPI assigned

Nov 6, 2006

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Physician Assistant

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1083783237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 S PHILLIPS ST",
            "city": "ALGONA",
            "state": "IA",
            "postal_code": "505113649",
            "telephone_number": "515-295-7714",
            "fax_number": "515-295-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 S PHILLIPS ST",
            "city": "ALGONA",
            "state": "IA",
            "postal_code": "505113649",
            "telephone_number": "515-295-7714",
            "fax_number": "515-295-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARC",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "000846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "36656",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "51939",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Algona, IA

• Anne H Nerison, AU.D.
• North Central Iowa Mental Health Center, Inc
• North Central Iowa Mental Health Center, Inc
• Northwest Iowa Dermatology LLC
• Brent David Owen, MD
• Allison Marie Rausch
• Judy Rae Reinking, DPM
• Stephen D Richards, DO
• Heather Ileane Ricklefs, PHARMD
• Reese Rosenmeyer

All providers in Algona, IA · Physician Assistant in Iowa