TIMOTHY A PETERSON (NPI# 1134211568) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134211568 |
| Entity Type | Individual |
| Full Name | TIMOTHY A PETERSON |
| Credential | MD |
| Practice Address |
4700 S Washington St Ste G Grand Forks ND 58201-8123 |
| Mailing Address |
Po Box 5210 Grand Forks ND 58206-5210 |
| Practice Telephone | 7012053000 |
| Practice Fax Number | 7017322501 |
| Mailing Telephone | 7012053000 |
| Mailing Fax Number | 7017322501 |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2020-10-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 7777 | ND | Allopathic & Osteopathic Physicians |
| Y | 2083A0300X | 7777 | ND |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 1456145 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023178738 | Timothy Lee Peterson | Pharmacist | 1010 Enterprise Dr E, Belle Plaine, MN 56011-2340 | 2006-12-11 |
| 1992887376 | Timothy K. Peterson | Physician Assistant | 2891 E Grant St, Roma, TX 78584 | 2006-10-19 |
| 1609956481 | Timothy John Peterson | Chiropractor | 10135 Hwy Ss, Bloomer, WI 54724 | 2006-10-16 |
| 1528041886 | Timothy D Peterson | Emergency Medicine | 108 Sutton Place, Taos Ski Valley, NM 87525-0067 | 2005-11-21 |
| 1265049043 | Timothy Charles Peterson | Pharmacist | 1400 E 2nd St, Edmond, OK 73034-5321 | 2020-09-25 |
| 1740742725 | Timothy Scott Peterson | Student in an Organized Health Care Education/Training Program | 2301 Erwin Rd, Durham, NC 27705-4699 | 2019-04-01 |
| 1497259360 | Timothy James Peterson | Student in an Organized Health Care Education/Training Program | 1740 W Taylor St, Chicago, IL 60612-7232 | 2018-03-23 |
| 1992189328 | Timothy James Peterson | Counselor | 12025 115th Ave Ne, Bldg D Suite 200, Kirkland, WA 98034-6942 | 2015-07-15 |
| 1730518044 | Timothy Terrence Peterson | Pharmacist | 4500 Commercial St Se, Salem, OR 97302-3918 | 2013-11-06 |
| 1922362490 | Timothy Peterson | Family Medicine | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2012-06-29 |
| Street Address |
4700 S WASHINGTON ST STE G |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201-8123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306819941 | David B Eberly | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2006-02-13 |
| 1073137915 | Hannah Lee Abner | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8155 | 2020-06-06 |
| 1255961959 | Mallory Kristen Martha | Registered Nurse | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2020-01-22 |
| 1023663598 | Devon Nicole Anderson | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2019-08-01 |
| 1255983888 | Danielle Collins | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2019-07-13 |
| 1659889798 | Natasha Marie Krebs | Registered Nurse | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2018-01-10 |
| 1730695412 | Mio Watanabe | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2017-12-18 |
| 1972012482 | Mallory Driscoll | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2017-09-27 |
| 1699295774 | Peterson Medical Clinics, LLC | Clinic/Center | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2017-06-21 |
| 1073067823 | Riki Gifford-ferguson | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2016-08-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
Please comment or provide details below to improve the information on TIMOTHY A PETERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.