Healthcare Provider Details

I. General information

NPI: 1619321197
Provider Name (Legal Business Name): ERIK PETERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SIOUX FALLS VA MEDICAL CENTER 2501 WEST 22ND ST
SIOUX FALLS SD
57105
US

IV. Provider business mailing address

SIOUX FALLS VA MEDICAL CENTER 2501 WEST 22ND ST
SIOUX FALLS SD
57105
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-3230
  • Fax:
Mailing address:
  • Phone: 605-336-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO-05239
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: