Provider Demographics
NPI:1609980473
Name:PETERSON, RONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1826
Mailing Address - Country:US
Mailing Address - Phone:406-653-2150
Mailing Address - Fax:406-653-6591
Practice Address - Street 1:301 KNAPP ST
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1826
Practice Address - Country:US
Practice Address - Phone:406-653-2150
Practice Address - Fax:406-653-6591
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT4695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00705-1OtherBCBS OF MT
E41126Medicare UPIN