Active NPI
Michael Peterson, MD
- Ophthalmology Physician
- Missoula, MT
National Provider Identifier
1114911831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 6492
- Practice address
- 700 W Kent Ave
Missoula, MT 59801-6772 - Phone
- (406) 541-3937
- Fax
- (406) 541-1810
- NPI assigned
- Sep 8, 2005
- Last updated
- Apr 14, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 6492 | MT | Primary |
Addresses
Primary practice location
700 W Kent Ave
Missoula, MT 59801-6772
Mailing address
700 W Kent Ave
PO Box 4907
Missoula, MT 59801-6772
Phone (406) 541-3937
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 081471 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6492 | MT | MD | Ophthalmology Physician |
Interoperability endpoints
- mpeterson@rockymountaineye.intellechartdirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271203200000",
"number": "1114911831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 W KENT AVE",
"address_2": "PO BOX 4907",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598016772",
"telephone_number": "406-541-3937",
"fax_number": "406-541-1810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 W KENT AVE",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598016772",
"telephone_number": "406-541-3937",
"fax_number": "406-541-1810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-08",
"last_updated": "2010-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MT",
"license": "6492",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "081471",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.