Douglas Peterson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

22930 Issued in MN

Practice address

1630 Anderson Ave
Buffalo, MN 55313-2945

Phone

(800) 876-7171

NPI assigned

Dec 13, 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Healtheast Medical Research Institute

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1508191552
  NPD (past)
• National Dizzy & Balance Center,LTD.

  • Physical Medicine & Rehabilitation Physician
  • Bloomington, MN
  • NPI 1023021938
  NPD (past)
• United Hospital District Inc.

  • Rural Health Clinic/Center
  • Fairmont, MN
  • NPI 1144984766
  NPD (past)

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1710962832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5008 QUEEN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554102207",
            "telephone_number": "612-929-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 ANDERSON AVE",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553132945",
            "telephone_number": "800-876-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DOUGLAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "22930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "92M48PE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "92M48PE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146290300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• PCC, Inc
• Jonathan Eric Pearson, PTA
• Jamie Pederson, RN
• Mark Pederson, LP
• Performance and Wellness, Inc
• Melissa Pfaff, RN
• Shannon Pfeifer
• Richard James Phipps II, CRNA
• Tricia Pirsig, LADC
• Jaime Ellen Plamann, MOTR/L

• Emergency Medicine Physician in Buffalo, MN
• Providers in Buffalo, MN by specialty
• Emergency Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.