Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 871 | MN |
NPI | 1083840664 |
---|---|
Provider Name | Dr. Matthew Christian Peterson |
First Address | Edina, MN 55435-2180 |
Second Address | Edina, MN 55435-2180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 29/09/2015 |