MR. GARY M PETERSON (NPI# 1699724955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699724955 |
| Entity Type | Individual |
| Full Name | MR. GARY M PETERSON |
| Credential | M.D. |
| Practice Address |
4702 Grand Ave Duluth MN 55807-2742 |
| Practice Telephone | 2182496800 |
| Practice Fax Number | 2182496808 |
| Mailing Telephone | 2182496800 |
| Mailing Fax Number | 2182496808 |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2017-01-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 28567 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 611373700 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417299074 | Gary L Peterson | Veterinarian | 1220 S State St, Salt Lake City, UT 84111-4535 | 2013-03-21 |
| 1447557616 | Gary G Peterson | Physical Therapist | 4461 Woodbridge Rd, Niceville, FL 32578-2387 | 2011-02-23 |
| 1114130465 | Gary Glen Peterson | Psychologist | 675 Sun Valley Road, C, Ketchum, ID 83340 | 2007-05-07 |
| 1518006147 | Gary S Peterson | Dentist | 123 S Stone Ave, Tucson, AZ 85701-1914 | 2007-02-06 |
| 1164589610 | Gary Robert Peterson | Counselor | 1538 The Greens Way Ste 101, Jacksonville Beach, FL 32250-1400 | 2007-01-03 |
| 1285799304 | Gary Ray Peterson | Dentist | 3815 Stephens Ave, Missoula, MT 59801-8505 | 2006-12-27 |
| 1629163514 | Gary Lee Peterson | Chiropractor | 7100 Menaul Blvd Ne, Albuquerque, NM 87110-3688 | 2006-10-04 |
| 1417065566 | Gary Peterson | Psychiatry & Neurology | 103 Edwards Ridge Rd, Chapel Hill, NC 27517-9201 | 2006-08-28 |
| 1831541812 | Gary Daniel Peterson | Anesthesiology | 6000 Hospital Dr, Hannibal, MO 63401-6887 | 2016-07-01 |
| 1114384039 | Gary Peterson | Counselor | 8495 Crater Lake Hwy, White City, OR 97503-3011 | 2016-01-22 |
| Street Address |
4702 GRAND AVE |
| City | DULUTH |
| State | MN |
| Zip Code | 55807-2742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790042182 | Elisabeth Jane Gibbons | Family Medicine | 4702 Grand Ave, Duluth, MN 55807-2742 | 2012-04-23 |
| 1386849180 | Erica Marie Williams | Nurse Practitioner | 4702 Grand Ave, Duluth, MN 55807-2742 | 2007-06-20 |
| 1639123334 | St. Luke's Hospital of Duluth | Preventive Medicine | 4702 Grand Ave, Duluth, MN 55807-2742 | 2006-05-19 |
| 1144273749 | Eric Charles Enberg | Family Medicine | 4702 Grand Ave, Duluth, MN 55807-2742 | 2006-05-18 |
| 1033161161 | St. Luke's Hospital of Duluth | Family Medicine | 4702 Grand Ave, Duluth, MN 55807-2742 | 2006-05-17 |
| 1902857071 | Douglas M Wendland | Preventive Medicine | 4702 Grand Ave, Duluth, MN 55807-2742 | 2006-05-13 |
| 1649220641 | Nichole Marie Schaefer | Family Medicine | 4702 Grand Ave, Duluth, MN 55807-2742 | 2006-05-11 |
| 1376593517 | Steven L. Foltz | Physician Assistant | 4702 Grand Ave, Duluth, MN 55807-2742 | 2006-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568918126 | Jaime Lynn Mallory | Counselor | 4000 W 9th St., Duluth, MN 55807 | 2016-09-01 |
| 1568817138 | Fathers Rise Together | Community/Behavioral Health | 319 N 22nd Ave West, Duluth, MN 55807 | 2016-05-02 |
| 1558660357 | Melissa June Huray | Counselor | 326 North Central Avenue, Duluth, MN 55807 | 2011-03-18 |
| 1376757682 | Chiropractic Health Center P A | Chiropractor | 215 North Central Ave, Duluth, MN 55807 | 2007-05-09 |
| 1639235914 | Mark Andrew Nelson Albee | Social Worker | 4214 Grand Avenue, Duluth Clinic-west, Duluth, MN 55807 | 2006-12-29 |
| 1851457758 | Northwood Children's Services, Inc. | Counselor | 4000 W 9th St, Duluth, MN 55807 | 2006-12-28 |
| 1679934012 | Rebecca Ann Peterson | Nurse Practitioner | 4325 Grand Ave, Duluth, MN 55807 | 2016-03-13 |
| 1326134529 | Jane Patricia Rudd | Family Medicine | 4212 Grand Ave, Duluth, MN 55807 | 2006-10-05 |
| 1548290257 | Kirsten I Bich | Family Medicine | 4212 Grand Ave, Essentia Health West Duluth Clinic, Duluth, MN 55807 | 2006-07-05 |
| 1033140660 | Wendell R Bonner | Family Medicine | 4212 Grand Ave, Duluth, MN 55807 | 2006-07-05 |
| Find all providers in zip 55807 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811553084 | Clement Ayanbadejo LLC | Family Medicine | 2282 Meadow Church Rd Ste 200, Duluth, GA 30097-5318 | 2019-05-14 |
| 1902391923 | Young-tae Kim | Family Medicine | 3610 Peachtree Industrial Blvd Ste 100, Duluth, GA 30096-5139 | 2018-06-22 |
| 1659655538 | Primary Care of Atlanta | Family Medicine | 4124 Chattahoochee Trce, Ste 103, Duluth, GA 30097-2147 | 2011-10-10 |
| 1639462997 | James F Conniff | Family Medicine | Duluth Family Medicine Clinic, 330 N Eighth Ave E, Duluth, MN 55805 | 2011-05-19 |
| 1497087126 | St. Luke's Hospital of Duluth | Family Medicine | 6351 E. Superior St., Duluth, MN 55804-2545 | 2010-02-05 |
| 1861729816 | Mark Steven Grimsley | Family Medicine | 1611 Satellite Blvd Ste 3, Duluth, GA 30097 | 2009-11-12 |
| 1154552990 | Clement O Ayanbadejo | Family Medicine | 2282 Meadow Church Rd, Ste 200, Duluth, GA 30097-5318 | 2009-07-28 |
| 1891950457 | Liem Chi Ngo | Family Medicine | 4470 Satellite Blvd, Suite 204, Duluth, GA 30096-8851 | 2008-07-23 |
| 1962663302 | Martin Charles Hinz | Family Medicine | 1150 88th Ave W, Duluth, MN 55808-1505 | 2008-06-18 |
| 1447422506 | Onelio Emilio Perdomo | Family Medicine | 3750 Venture Drive, Suite 130, Duluth, GA 30096-1808 | 2008-03-28 |
| Find all providers in DULUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.