| Doctor Name: | JONATHAN PETERSON |
| NPI Number: | 1003882010 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 33320 |
| Business Practice Address: | 1200 Grant Blvd W Wabasha, MN - 559811042 |
| Business Phone Number: | 6515655908 |
| Business Fax Number: | 6515655910 |
| Mailing Address: | 1200 Grant Blvd W, WABASHA |
| State: | MN |
| Postal Code: | 559811042 |
| Phone Number: | 6515655908 |
| Fax Number: | 6515655910 |
| NPI Enumeration Date: | 02/28/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0805X |
| License Number: | 33320 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Geriatric Psychiatry |
| Taxonomy Definition: | Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. |