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NPI Code Detail

MEDICARE: TIMOTHY A PETERSON MD

MEDICARE: TIMOTHY A PETERSON MD
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
12083A0300XAddiction Medicine (Preventive Medicine) Physician7777ND
2207Q00000XFamily Medicine Physician7777ND
32084P0800XPsychiatry Physician7777ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134211568
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY A PETERSON MD
Provider Business Mailing Address
First Line : PO BOX 5210
Second Line :
City : GRAND FORKS
State : ND
Zip : 58206-5210
Country : US
Telephone Number : 701-205-3000
Fax Number : 701-732-2501
Provider Business Practice Location Address
First Line : 3674 S WASHINGTON ST
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-5766
Country : US
Telephone Number : 701-205-3000
Fax Number : 701-732-2501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2006
Last Update Date : 04/13/2026

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Directions to “ TIMOTHY A PETERSON MD” Practice Location

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