Jerry R Petersen, MD Valid NPI
Individual provider · Family Medicine Physician · Spring Park, MN
- NPI
- 1467451344
- Type
- Individual (Type 1)
- Primary specialty
- Family Medicine Physician (Family Medicine)
- Specialty group
- Allopathic & Osteopathic Physicians
- Taxonomy code
- 207Q00000X
- License number
- 20372 (MN)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2005-07-21
- Last updated
- 2008-05-12
Practice location
4695 Shoreline Dr
Spring Park, MN 55384-9715
(952) 442-7890