Provider Demographics
NPI:1043270556
Name:PETERSON, DARWIN DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DARWIN
Middle Name:DEAN
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3541
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:540 E JEFFERSON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2477
Practice Address - Country:US
Practice Address - Phone:319-688-7880
Practice Address - Fax:319-688-7881
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02331208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA020047262OtherMEDICARE RR
IA0210807Medicaid
IA19971OtherBLUE CROSS #
IA19971Medicare ID - Type UnspecifiedMEDICARE #
IA0210807Medicaid