Provider Demographics
NPI:1023087376
Name:DALY, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:DALY
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 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5042
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:17 EXCHANGE ST W
Practice Address - Street 2:SUITE 307
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1223
Practice Address - Country:US
Practice Address - Phone:651-842-5200
Practice Address - Fax:651-223-5903
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30908207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN485500100Medicaid
MN200012413OtherRAILROAD MEDICARE
MNE98402Medicare UPIN
MN200012413OtherRAILROAD MEDICARE