Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jerry R Petersen, MD

Individual provider Family Medicine Physician · NPI 1467451344

Jerry R Petersen, MD is a Family Medicine Physician in Spring Park, Minnesota. Licensed in Minnesota. Registered with an NPI since 2005.

Licensed in
MN
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

4695 Shoreline Dr
Spring Park, MN 55384-9715
Phone: (952) 442-7890
Fax: (952) 442-7893
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 20372 (MN)

Record details

NPI number1467451344
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 21, 2005
Last updated in NPPESMay 12, 2008
Mailing address4695 Shoreline Dr, Spring Park, MN 55384-9715

Other providers in Spring Park