Gary D Peterson, MD
Individual provider Active NPI Pediatrics Physician · Dickinson, ND
NPI 1821180050 · NPPES record last updated Sep 11, 2007
Key facts
- NPI
- 1821180050
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 7827 (ND)
- Practice address
- 938 2ND Ave W
Dickinson, ND 58601-3916 - Phone
- (701) 456-6000
- Fax
- (701) 323-5709
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10758 | AZ | MD | Marriage & Family Therapist |
| 7827 | ND | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 7827 | ND | Yes |
Addresses
Primary practice location
938 2ND Ave W
Dickinson, ND 58601-3916
Mailing address
PO Box 5501
Bismarck, ND 58506-5501
Phone (701) 323-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10421 | Medicaid | ND |
Other providers in Dickinson, ND
- Haylee Peters
- Thomas James Peters
- Timothy J Peters
- Braydon D Peterson
- Brody William Peterson
- Kami L Peterson
- Shantelle Lace Petroff
- Annah Peyiye
- Jordyn Alese Phelps
- Linda R Plaggemeyer
All providers in Dickinson, ND · Pediatrics Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 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.