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DR. GARY J PETERSON MD
NPI 1902900517
Surgery - Vascular Surgery in Saint Louis, MO

Active since September 12, 2006
10012 KENNERLY RD, SUITE 305, SAINT LOUIS, MO 63128(314) 525-4325(314) 525-4365 Get Directions Write a Review

NPPES record last updated: May 24, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Gary J Peterson Md NPPES

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

DR. GARY J PETERSON MD (NPI 1902900517) is an individual vascular surgery provider in Saint Louis, Missouri, licensed in Missouri (R5836) and active in the NPI registry since September 2006.

NPPES Registry Identity

NPI1902900517
Entity TypeIndividualMale
Primary Taxonomy2086S0129X
Provider Legal NameDR. GARY J PETERSONCredential: MD
Location Address10012 KENNERLY RD, SUITE 305Saint Louis, MO 63128-2197
Mailing Address10012 Kennerly Rd, Suite 305Saint Louis, MO 63128-2197 · (314) 525-4325 · Fax (314) 525-4365
Phone(314) 525-4325
Fax(314) 525-4365
Sole ProprietorNo
Enumeration DateSeptember 12, 2006
Last NPPES UpdateMay 24, 2016
✔ NPI 1902900517 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Vascular SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0129X
License✔ Licensed in MO · R5836
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
10012 KENNERLY RD, Saint Louis, MO 63128
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Other Identifiers 2

Medicaid1902900517MO
Medicare PINMA3163034MO

Other Providers at the Same Location NPPES 20

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

DR. CHRISTOPHER CHARLES BOWE MD
Internal Medicine
10012 KENNERLY RD, SUITE 102
SAINT LOUIS, MO 63128
St. Louis County (314) 525-4225
DR. YAZAN A ABDALLA M.D.
Internal Medicine (Gastroenterology)
10012 KENNERLY RD, SUITE 404
SAINT LOUIS, MO 63128
St. Louis County (314) 543-5911
JEANE E KIENE FNP-C
Nurse Practitioner (Family)
10012 KENNERLY RD, SUITE 300
SAINT LOUIS, MO 63128
St. Louis County (314) 842-0602
ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
Obstetrics & Gynecology
10012 KENNERLY RD, STE 405
SAINT LOUIS, MO 63128
St. Louis County (314) 525-4880
KATHLEEN L FISHER RN, BC, ANP
Nurse Practitioner (Adult Health)
10012 KENNERLY RD, SUITE 204
SAINT LOUIS, MO 63128
St. Louis County (314) 525-1220
DR. ROBERT FRED BECKMAN M.D.
Surgery
10012 KENNERLY RD, SUITE 406
SAINT LOUIS, MO 63128
St. Louis County (314) 525-1224
DR. THOMAS BENJAMIN MORRISON MD
Internal Medicine (Cardiovascular Disease)
10012 KENNERLY RD, STE 300
SAINT LOUIS, MO 63128
St. Louis County (314) 842-0602
DR. CHARLES F CAREY M.D.
Internal Medicine (Cardiovascular Disease)
10012 KENNERLY RD, STE 300
SAINT LOUIS, MO 63128
St. Louis County (314) 842-0602

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 Gary Peterson's NPI number?

The NPI number for Gary Peterson is 1902900517. It was assigned to this individual provider in the NPPES registry on September 12, 2006.

Where is Gary Peterson located?

Gary Peterson practices at 10012 Kennerly Rd Suite 305, Saint Louis, MO 63128. The listed phone number is (314) 525-4325.

What is Gary Peterson's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.

When was this NPI record last updated?

The NPPES record for Gary Peterson was last updated on May 24, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.