DR. PAUL CHARLES PETERSON (NPI# 1902805518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902805518 |
| Entity Type | Individual |
| Full Name | DR. PAUL CHARLES PETERSON |
| Credential | MD |
| Practice Address |
1200 6th Ave N Saint Cloud MN 56303-2735 |
| Mailing Address |
1200 6th Ave N Saint Cloud MN 56303-2736 |
| Practice Telephone | 3202557891 |
| Practice Fax Number | 3202555882 |
| Mailing Telephone | 3202557891 |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2020-04-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 200300395 | NC | Allopathic & Osteopathic Physicians |
| Y | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
64851 | MN | Allopathic & Osteopathic Physicians |
| N | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
200300395 | NC | Allopathic & Osteopathic Physicians |
| N | 2084S0012X |
Psychiatry & Neurology Specialization: Sleep Medicine |
200300395 | NC | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134769979 | Paul Peterson | Non-emergency Medical Transport (VAN) | 4314 45th St N, Fargo, ND 58102-6915 | 2020-01-09 |
| 1013304500 | Paul Carlton Peterson | Home Health Aide | 712 4th St Ne, Washington, DC 20002-4316 | 2015-04-22 |
| 1083902126 | Paul H Peterson | Podiatrist | 1420 109th Ave Ne Ste 100, Blaine, MN 55449-3603 | 2011-07-11 |
| 1245498971 | Paul Stephen Peterson | Physician Assistant | 5731 Silverstone Ter Ste 100, Colorado Springs, CO 80919-3594 | 2008-05-29 |
| 1285752642 | Paul Arthur Peterson | Specialist/Technologist | 46400 Algonkian Pkwy, Potomac Falls, VA 20165-6487 | 2007-03-26 |
| 1528114667 | Paul Joseph Peterson | Social Worker | 1459 N Main St Ste 100, Bountiful, UT 84010-6092 | 2007-01-25 |
| 1194876672 | Paul Gabriel Peterson | Student in an Organized Health Care Education/Training Program | Wramc Department of Radiology, 6900 Georgia Ave. Nw, Bldg. 2, Washington, DC 20307-0001 | 2007-01-13 |
| 1972678993 | Paul Stanley Peterson | Chiropractor | 4616 El Camino Ave, Sacramento, CA 95821-6736 | 2006-11-22 |
| 1275646465 | Paul J Peterson | Social Worker | 102 Southend Dr, Dayton, NV 89403-7414 | 2006-08-15 |
| 1326013426 | Paul D Peterson | Family Medicine | 2600 Outer Dr N, Sioux City, IA 51104-1585 | 2006-02-22 |
| Street Address |
1200 6TH AVE N |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-2735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871127290 | Kayla Girgen | Dietitian, Registered | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2020-02-25 |
| 1023640034 | Faith Kelly Dammann | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2020-02-07 |
| 1538707377 | Alissa Wigen | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-12-11 |
| 1639713290 | Jordan Lajoie | Nurse Practitioner | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-11-06 |
| 1528602430 | Hannah Elise Osterndorf | Dietitian, Registered | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-11-04 |
| 1558919100 | Mergitu Megersa Gemeda | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2019-08-27 |
| 1659927879 | Jennifer Marie Bretscher | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-08-13 |
| 1366094302 | Laura Verley | Registered Nurse | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2019-07-10 |
| 1063074235 | Briana Gray | Pharmacist | 1200 6th Ave N, Internal Medicine, Saint Cloud, MN 56303-2735 | 2019-07-08 |
| 1306403738 | Katharine Imrie | Genetic Counselor, MS | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-05-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 2084V0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Vascular Neurology |
| Vascular Neurology is a subspecialty in the evaluation, prevention, treatment and recovery from vascular diseases of the nervous system. This subspecialty includes the diagnosis and treatment of vascular events of arterial or venous origin from a large number of causes that affect the brain or spinal cord such as ischemic stroke, intracranial hemorrhage, spinal cord ischemia and spinal cord hemorrhage. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972859767 | Ivan Rafael Matos Diaz | Psychiatry & Neurology | 701 Park Ave, Minneapolis, MN 55415-1623 | 2012-07-30 |
| 1477725133 | Ellie Eun Ju Choi | Psychiatry & Neurology | 401 Phalen Blvd, Mail Stop 41104c, Saint Paul, MN 55130-5302 | 2008-04-01 |
| City | SAINT CLOUD |
| Zip Code | 56303 |
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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.