Provider Demographics
NPI:1720341225
Name:PELTIER, JOSHUA JERALD (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JERALD
Last Name:PELTIER
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 1:640 JACKSON ST
Mailing Address - Street 2:MC11102F
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-3666
Mailing Address - Fax:651-254-5216
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MC11102F
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3666
Practice Address - Fax:651-254-5216
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI63763-20207P00000X
MN59212207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine