Healthcare Provider Details

I. General information

NPI: 1336126721
Provider Name (Legal Business Name): AARON THOMAS PETERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WAGON TRAIL AVE
LAS VEGAS NV
89118-4426
US

IV. Provider business mailing address

3600 MINNESOTA DR STE 800
EDINA MN
55435-7915
US

V. Phone/Fax

Practice location:
  • Phone: 702-942-4123
  • Fax: 702-942-4124
Mailing address:
  • Phone: 952-595-1100
  • Fax: 612-294-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036116322
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number12283
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12283
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: