MEDICARE: DR. DARWIN DEAN PETERSON D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	02331	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020047262	OTHER	IA	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	19971	OTHER	IA	BLUE CROSS #

General Provider Information

NPI Number	:	1043270556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARWIN DEAN PETERSON D.O.

Provider Business Mailing Address
First Line	:	PO BOX 2027
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52244-2027
Country	:	US
Telephone Number	:	319-339-3541
Fax Number	:	319-358-2737

Provider Business Practice Location Address
First Line	:	540 E JEFFERSON ST
Second Line	:	SUITE 205
City	:	IOWA CITY
State	:	IA
Zip	:	52245-2477
Country	:	US
Telephone Number	:	319-688-7880
Fax Number	:	319-688-7881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	06/24/2015

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Directions to “ DR. DARWIN DEAN PETERSON D.O.” Practice Location

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