Mark Delano Peterson, MD

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

MD18861 Issued in OR

Practice address

1311 E Barnett Rd
Ste 201
Medford, OR 97504-8225

Phone

(541) 779-5007

Fax

(541) 779-5022

NPI assigned

Oct 12, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Southern Oregon Spine Care, P.C.

  • Orthopaedic Surgery of the Spine Physician
  • Medford, OR
  • NPI 1912349580
  NPD Authorized official

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379376000000",
    "number": "1699763607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 E BARNETT RD",
            "address_2": "STE 201",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048225",
            "telephone_number": "541-779-5007",
            "fax_number": "541-779-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 E BARNETT RD",
            "address_2": "STE 201",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048225",
            "telephone_number": "541-779-5007",
            "fax_number": "541-779-5022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARK",
        "middle_name": "DELANO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2013-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "OR",
            "license": "MD18861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128129",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Peterson
• Audrey Peterson, PA
• Earl Duane Peterson, MD
• John Peterson
• Judy Patricia Peterson
• Suzanne Peterson, LMFT, CADC-IT
• Trevor Peterson, DMD
• Benjamin Petetit
• Elizabeth L Pethtel, FNP
• Kelly A Pettinger, DVM

• Orthopaedic Surgery of the Spine Physician in Medford, OR
• Providers in Medford, OR by specialty
• Orthopaedic Surgery of the Spine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.