MARK DELANO PETERSON (NPI# 1699763607) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699763607 |
| Entity Type | Individual |
| Full Name | MARK DELANO PETERSON |
| Credential | MD |
| Practice Address |
1311 E Barnett Rd Ste 201 Medford OR 97504-8225 |
| Practice Telephone | 5417795007 |
| Practice Fax Number | 5417795022 |
| Mailing Telephone | 5417795007 |
| Mailing Fax Number | 5417795022 |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2013-09-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
MD18861 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 128129 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164069696 | Mark Alan Peterson | In Home Supportive Care | 5870 Nw 54th Ct, Johnston, IA 50131-1418 | 2019-12-03 |
| 1841474012 | Mark Frederic Peterson I | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3351 36th St, Grand Rapids, MI 49331 | 2007-12-24 |
| 1780877258 | Mark A. Peterson | Counselor | 7322 Scenic Oaks Cir, Austin, TX 78745-5217 | 2007-08-19 |
| 1871702076 | Mark Clayton Peterson | Dentist | 1600 W Sunset Rd Ste B, Henderson, NV 89014-2655 | 2007-05-22 |
| 1558481366 | Mark Theodore Peterson | Specialist | 5712 Newburg Rd, Rockford, IL 61108-6707 | 2007-03-29 |
| 1073608170 | Mark A Peterson | Dentist | 7740 Bay St, Suite # 1, Sebastian, FL 32958-3427 | 2006-10-04 |
| 1689782864 | Mark L Peterson | Dentist | 127 1/2 E Short St, Rigby, ID 83442-1422 | 2006-08-28 |
| 1528013661 | Mark Edward Peterson | Dentist | 2440 Gaynor Nw, Grand Rapids, MI 49544-1830 | 2006-05-24 |
| 1477551836 | Mark Dean Peterson | Chiropractor | 5406 Alderson St, Schofield, WI 54476-2264 | 2005-07-11 |
| 1477043842 | Mark Peterson | Student in an Organized Health Care Education/Training Program | 1115 20th St Ste 205, Huntington, WV 25703-2071 | 2018-05-11 |
| Street Address |
1311 E BARNETT RD STE 201 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-8225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437424348 | Joann Lanae Reed | Nurse Practitioner | 1311 E Barnett Rd, Suite 201, Medford, OR 97504-8225 | 2012-03-12 |
| 1558688697 | Erik Christian Anders Olsson | Orthopaedic Surgery | 1311 E Barnett Rd, Suite 201, Medford, OR 97504-8225 | 2010-04-29 |
| 1396759916 | Thomas Jason Trubenbach | Nurse Practitioner | 1311 E Barnett Rd, Suite 201, Medford, OR 97504-8225 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912349580 | Southern Oregon Spine Care, P.C. | Orthopaedic Surgery | 1311 Barnett Road Ste 201, Medford, OR 97504 | 2013-07-24 |
| 1558688697 | Erik Christian Anders Olsson | Orthopaedic Surgery | 1311 E Barnett Rd, Suite 201, Medford, OR 97504-8225 | 2010-04-29 |
| 1609040377 | Andy Jon Kranenburg | Orthopaedic Surgery | 2780 E Barnett Rd Ste 200, Medford, OR 97504-8674 | 2008-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932607215 | Spine Cin of Oregon LLC | Orthopaedic Surgery | 1867 Williams Hwy Ste 287, Grants Pass, OR 97527-5854 | 2018-01-31 |
| 1023516309 | Joint Replacement Cin of Oregon LLC | Orthopaedic Surgery | 1867 Williams Hwy Ste 288, Grants Pass, OR 97527-5856 | 2018-01-31 |
| 1063722262 | Centennial Medical Group North, LLC | Orthopaedic Surgery | 2801 Nw Mercy Dr Ste 340, Roseburg, OR 97471-2348 | 2010-10-21 |
| 1295779734 | Todd Jay Lewis | Orthopaedic Surgery | 2211 Nw Professional Dr, Ste 100, Corvallis, OR 97330-3887 | 2006-06-15 |
| 1548722614 | Sor Care of Or, LLC | Orthopaedic Surgery | 1867 Williams Hwy Ste 287, Grants Pass, OR 97527-5854 | 2019-04-05 |
| 1942702642 | Robert L Tatsumi Md PC | Orthopaedic Surgery | 19255 Sw 65th Ave Ste 200, Tualatin, OR 97062-9712 | 2018-03-08 |
| 1043605454 | Michael Wheeler | Orthopaedic Surgery | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3098 | 2015-04-02 |
| 1700203338 | Renuka Reddy Kuruvalli | Orthopaedic Surgery | 3181 Sw Sam Jackson Park Rd, Orthopaedic and Rehabilitaion Department, Portland, OR 97239-3011 | 2014-03-20 |
| 1376972182 | Oregon Spine Care LLC | Orthopaedic Surgery | 19255 Sw 65th Ave, Suite 200, Tualatin, OR 97062-7451 | 2013-11-02 |
| 1164860193 | Satoshi Kawaguchi | Orthopaedic Surgery | 3181 Sw Sam Jackson Park Rd, Op31, Portland, OR 97239-3011 | 2013-06-12 |
| Find all providers with the same taxonomy | ||||
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| 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.