Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 27010 | MN |
Y | 207QS0010X | Family Doctor - Sports Medicine | 27010 | MN |
NPI | 1225089576 |
---|---|
Provider Name | James Frederick Peters |
First Address | Edina, MN 55439-2516 |
Second Address | Edina, MN 55439-2516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 27/02/2014 |