| Doctor Name: | PETER PAUL FODERICK |
| NPI Number: | 1336315043 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 13953 |
| Business Practice Address: | 506 4th Ave W 506 Fourth Ave.w Ada, MN - 565101011 |
| Business Phone Number: | 2187844848 |
| Business Fax Number: | |
| Mailing Address: | 506 Fourth Ave.w, P.o.box189 ADA |
| State: | MN |
| Postal Code: | 565100189 |
| Phone Number: | 2187844848 |
| Fax Number: | |
| NPI Enumeration Date: | 05/02/2008 |
| NPI Last Update Date: | 05/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 13953 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |