DR. GARY J PETERSON (NPI# 1902900517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902900517 |
| Entity Type | Individual |
| Full Name | DR. GARY J PETERSON |
| Credential | MD |
| Practice Address |
10012 Kennerly Rd Suite 305 Saint Louis MO 63128-2197 |
| Practice Telephone | 3145254325 |
| Practice Fax Number | 3145254365 |
| Mailing Telephone | 3145254325 |
| Mailing Fax Number | 3145254365 |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2016-05-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
R5836 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1902900517 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417299074 | Gary L Peterson | Veterinarian | 1220 S State St, Salt Lake City, UT 84111-4535 | 2013-03-21 |
| 1447557616 | Gary G Peterson | Physical Therapist | 4461 Woodbridge Rd, Niceville, FL 32578-2387 | 2011-02-23 |
| 1114130465 | Gary Glen Peterson | Psychologist | 675 Sun Valley Road, C, Ketchum, ID 83340 | 2007-05-07 |
| 1518006147 | Gary S Peterson | Dentist | 123 S Stone Ave, Tucson, AZ 85701-1914 | 2007-02-06 |
| 1164589610 | Gary Robert Peterson | Counselor | 1538 The Greens Way Ste 101, Jacksonville Beach, FL 32250-1400 | 2007-01-03 |
| 1285799304 | Gary Ray Peterson | Dentist | 3815 Stephens Ave, Missoula, MT 59801-8505 | 2006-12-27 |
| 1629163514 | Gary Lee Peterson | Chiropractor | 7100 Menaul Blvd Ne, Albuquerque, NM 87110-3688 | 2006-10-04 |
| 1417065566 | Gary Peterson | Psychiatry & Neurology | 103 Edwards Ridge Rd, Chapel Hill, NC 27517-9201 | 2006-08-28 |
| 1699724955 | Gary M Peterson | Family Medicine | 4702 Grand Ave, Duluth, MN 55807-2742 | 2006-05-06 |
| 1831541812 | Gary Daniel Peterson | Anesthesiology | 6000 Hospital Dr, Hannibal, MO 63401-6887 | 2016-07-01 |
| Street Address |
10012 KENNERLY RD SUITE 305 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63128-2197 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154323376 | Minxiang Gu | Internal Medicine | 10012 Kennerly Rd, Suite 100, Saint Louis, MO 63128-2197 | 2005-06-01 |
| 1154935880 | Carol Bivins | Nurse Practitioner | 10012 Kennerly Rd, Saint Louis, MO 63128-2042 | 2020-09-01 |
| 1346705993 | Melissa Kay Wallis | Nurse Practitioner | 10012 Kennerly Rd, Saint Louis, MO 63128-2042 | 2019-02-07 |
| 1255833323 | Cameron Rousseau | Physician Assistant | 10012 Kennerly Rd, Saint Louis, MO 63128-2197 | 2018-03-05 |
| 1649721192 | Brittany Shoults | Nurse Practitioner | 10012 Kennerly Rd, Saint Louis, MO 63128-2197 | 2016-10-19 |
| 1366891137 | Emily Grace Peters | Nurse Practitioner | 10012 Kennerly Rd, Suite 202, Saint Louis, MO 63128-2197 | 2016-06-12 |
| 1194171033 | Rhonda G Haag | Nurse Practitioner | 10012 Kennerly Rd, Ste 101, Saint Louis, MO 63128-2197 | 2016-05-10 |
| 1669831293 | Kate E Lee | Nurse Practitioner | 10012 Kennerly Rd, Suite 300, Saint Louis, MO 63128-2197 | 2016-02-10 |
| 1477911857 | Aaron Rippelmeyer | Nurse Practitioner | 10012 Kennerly Rd, Suite 300, Saint Louis, MO 63128-2197 | 2016-02-01 |
| 1124492483 | Lesley Maria Endermuhle | Nurse Practitioner | 10012 Kennerly Rd, Ste 305, Saint Louis, MO 63128-2197 | 2015-11-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771155 | James T Fetsch Dmd LLC | Dentist | 10004 Kennerly Rd Suite 240, Saint Louis, MO 63128 | 2019-10-11 |
| 1326504655 | Nikodem Dental Holdings | Dentist | 4337 Butler Hill Rd Suite G, St Louis Mo, MO 63128 | 2019-02-12 |
| 1932678505 | Michelle Anne Arvidson | Physical Therapy Assistant | Elite Physical Therapy, 12608 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2018-11-13 |
| 1245726710 | Kristen Rider | Nurse Practitioner | 9964 Kennerly Rd Ste D, Saint Louis, MO 63128 | 2018-07-07 |
| 1306217427 | Sophia Bednarski | Dentist | 12660 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2015-10-15 |
| 1427434224 | Darcie Burrus | Counselor | 12523 Old Tesson Rd G, St Louis, MO 63128 | 2015-08-04 |
| 1710368584 | Sara Hawatmeh | Internal Medicine | 12345 W Bend Dr Ste 304, Saint Louis, MO 63128 | 2015-06-17 |
| 1871989590 | Celia Grace Montes-kolence | Speech-Language Pathologist | 12335 W Bend Drive, Saint Louis, MO 63128 | 2015-04-09 |
| 1245629302 | Marius Antonio Evans | Dentist | 9911 Kennerly Rd., Suite G, St. Louis, MO 63128 | 2015-01-13 |
| 1801230313 | Sarah Elizabeth Walsh | Emergency Medicine | 10010 Kennerly Road, Emergency Department, St. Anthony's Medical Center, St. Louis, MO 63128 | 2013-04-26 |
| Find all providers in zip 63128 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376801548 | Matthew Raymond Abate | Surgery | 10012 Kennerly Rd Ste 305, Saint Louis, MO 63128-2197 | 2012-04-25 |
| 1518992429 | Ayaz A Malik | Surgery | 1035 Bellevue Ave Ste 212, Saint Louis, MO 63117-1846 | 2006-07-11 |
| 1083687859 | Vidal T Sheen | Surgery | 11144 Tesson Ferry Rd, Suite 100, Saint Louis, MO 63123-6965 | 2006-02-10 |
| 1770145401 | Brian Patrick Sullivan | Surgery | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2019-07-02 |
| 1467947382 | Momodou L Jammeh | Surgery | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110 | 2018-06-22 |
| 1861912529 | Katherine Marie Holzem | Surgery | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2017-06-23 |
| 1922458892 | Bradley John Bowles | Surgery | 3635 Vista At Grand Boulevard, Saint Louis, MO 63110-4271 | 2016-06-21 |
| 1962852178 | Brandon D Downing | Surgery | 660 S Euclid Ave, Campus Box 8109, 5103a Queeny Tower, Saint Louis, MO 63110-1010 | 2016-06-18 |
| 1093078115 | John Westley Ohman | Surgery | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2012-06-22 |
| 1093946873 | Suaiman Syed Shoab | Surgery | 3655 Vista Ave, Saint Louis, MO 63110-2539 | 2009-07-28 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63128 |
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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.