Provider Demographics
NPI:1679563274
Name:NELSON, PETER E (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-240-2205
Mailing Address - Fax:320-229-5174
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-240-2205
Practice Address - Fax:320-229-5174
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28188207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2900211OtherMEDICA HEALTH PLANS
986021OtherPREFERRED ONE
HP25495OtherHEALTH PARTNERS
106184OtherU CARE
2114066OtherFIRST HEALTH PLAN
559249OtherARAZ GROUP
283285200OtherMEDICAL ASSISTANCE
486R2NEOtherBLUE CROSS BLUE SHIELD
6D080NEOtherBLUE CROSS BLUE SHIELD
486R2NEOtherBLUE CROSS BLUE SHIELD