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NPI Code Detail

MEDICARE: DR. JANE MARIE PETERSON MD

MEDICARE: DR. JANE MARIE 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
1207Q00000XFamily Medicine Physician38050MN

General Provider Information

NPI Number : 1821057662
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JANE MARIE PETERSON MD
Provider Business Mailing Address
First Line : 200 W 1ST ST
Second Line :
City : PAYNESVILLE
State : MN
Zip : 56362-1445
Country : US
Telephone Number : 320-243-3779
Fax Number : 320-243-7509
Provider Business Practice Location Address
First Line : 200 W 1ST ST
Second Line :
City : PAYNESVILLE
State : MN
Zip : 56362-1445
Country : US
Telephone Number : 320-243-3779
Fax Number : 320-243-7509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 01/05/2010

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