1. Home
  2. Directory
  3. Minnesota
  4. Spring Park
  5. Family Medicine
  6. NPI Profile

JERRY R PETERSEN MD
NPI 1467451344
Family Medicine in Spring Park, MN

Active since July 21, 2005
4695 SHORELINE DR, SPRING PARK, MN 55384(952) 442-7890(952) 442-7893 Get Directions Write a Review

NPPES record last updated: May 12, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jerry R Petersen Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JERRY R PETERSEN MD (NPI 1467451344) is an individual family medicine provider in Spring Park, Minnesota, licensed in Minnesota (20372) and active in the NPI registry since July 2005.

NPPES Registry Identity

NPI1467451344
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameJERRY R PETERSENCredential: MD
Location Address4695 SHORELINE DRSpring Park, MN 55384-9715
Mailing Address4695 Shoreline DrSpring Park, MN 55384-9715 · (952) 442-7890 · Fax (952) 442-7893
Phone(952) 442-7890
Fax(952) 442-7893
Sole ProprietorNo
Enumeration DateJuly 21, 2005
Last NPPES UpdateMay 12, 2008
✔ NPI 1467451344 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MN · 20372
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4695 SHORELINE DR, Spring Park, MN 55384
Open in Google Maps ↗

Other Identifiers 3

Other20372MN · Medical License
Medicare UPINA96536MN
Medicaid5093724700MO

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JULIE A DEJONG M.D.
Family Medicine
4695 SHORELINE DR
SPRING PARK, MN 55384
Hennepin County (952) 442-7890
JENNIFER H RYSSO
Internal Medicine
4695 SHORELINE DR
SPRING PARK, MN 55384
Hennepin County (952) 442-7890
JAMES D LEHMANN MD
Internal Medicine
4695 SHORELINE DR
SPRING PARK, MN 55384
Hennepin County (952) 442-7895
THOMAS G STOCKS MD
Internal Medicine
4695 SHORELINE DR
SPRING PARK, MN 55384
Hennepin County (952) 442-7890
STEVEN JAY NERHEIM M.D.
Family Medicine
4695 SHORELINE DR
SPRING PARK, MN 55384
Hennepin County (952) 442-7890
KEVIN M WHITE DO
Internal Medicine
4695 SHORELINE DR
SPRING PARK, MN 55384
Hennepin County (952) 442-7895
UROLOGY ASSOCIATES, LTD.
Urology
4695 SHORELINE DR
SPRING PARK, MN 55384
Hennepin County (763) 520-7700
RIDGEVIEW CLINICS
Orthopaedic Surgery
4695 SHORELINE DR
SPRING PARK, MN 55384
Hennepin County (952) 442-7895

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerry Petersen's NPI number?

The NPI number for Jerry Petersen is 1467451344. It was assigned to this individual provider in the NPPES registry on July 21, 2005.

Where is Jerry Petersen located?

Jerry Petersen practices at 4695 Shoreline Dr, Spring Park, MN 55384. The listed phone number is (952) 442-7890.

What is Jerry Petersen's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Jerry Petersen was last updated on May 12, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.