Healthcare Provider Details

I. General information

NPI: 1417410820
Provider Name (Legal Business Name): SETH C PETERSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LINCOLN CIR SE
ORANGE CITY IA
51041-1836
US

IV. Provider business mailing address

1000 LINCOLN CIR SE
ORANGE CITY IA
51041-1836
US

V. Phone/Fax

Practice location:
  • Phone: 712-737-2000
  • Fax: 712-737-2115
Mailing address:
  • Phone: 712-737-2000
  • Fax: 712-737-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-57104
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: