Gerald Dudley Peterson, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

118 Issued in OR

Practice address

1880 Willamette Falls Dr
Suite 111
West Linn, OR 97068-4652

Phone

(503) 657-1900

Fax

(503) 657-7744

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Foot Clinic LLC

  • Foot & Ankle Surgery Podiatrist
  • West Linn, OR
  • NPI 1538679196
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314576000000",
    "number": "1316983513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1880 WILLAMETTE FALLS DR",
            "address_2": "SUITE 111",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684652",
            "telephone_number": "503-657-1900",
            "fax_number": "503-657-7744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 WILLAMETTE FALLS DR",
            "address_2": "SUITE 111",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684652",
            "telephone_number": "503-657-1900",
            "fax_number": "503-657-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "GERALD",
        "middle_name": "DUDLEY",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2011-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF OREGON",
            "identifier": "930743342",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168161",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth M Perkins, PHARM. D.
• Heidi Peters, M.A., CCC-SLP
• Jeanie Elizabeth Petersen
• Lael R Petersen, LCSW
• Rita Petersen
• Benjamin Pham, DMD
• Linda Pham, L.M.T.
• Lynne Christine Piazza-Vitek, LMT
• Megan Pierson, PT, DPT
• Maddison Rylie Pitzl

• Foot & Ankle Surgery Podiatrist in West Linn, OR
• Providers in West Linn, OR by specialty
• Foot & Ankle Surgery Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.