Jeffrey Allen Peterson – Family Medicine Physician

Key facts

NPI: 1487734901
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 37670 (MN)
Practice address: 201 9TH St W
Ada, MN 56510-1243
Phone: (218) 784-5000
Fax: (218) 784-3753
NPI assigned: Oct 17, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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 Health Care Center Federally Qualified Health Center (FQHC) · Moorhead, MN · NPI 1043389117

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
6423	SD	MD	Ambulatory Care Pharmacist
37670	MN	MD	Family Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Family Health Care Center		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	37670	MN	Yes

Addresses

Primary practice location

201 9TH St W
Ada, MN 56510-1243

Mailing address

201 9TH St W
Ada, MN 56510-1243
Phone (218) 784-5000

Other identifiers

Identifier	Type	State	Issuer
37670	Other	MN	MN STATE LICENSE

Other providers in Ada, MN

All providers in Ada, MN · Family Medicine 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 9, 2007. 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.

Verify at the official NPI Registry.