MARK W PETERSON, MD LEWISTON, ID

Contact Information

MARK W PETERSON, MD

415 6TH ST
LEWISTON, ID 83501-2431

Phone: 208-799-5335
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Vascular & Interventional Radiology	2085R0204X	94	Physician/Interventional Radiology
Diagnostic Radiology	2085R0202X	30	Physician/Diagnostic Radiology

Indicates primary specialty

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NPI Profile & details for MARK W PETERSON · (Male)

NPI Number	`1356312524`
Status	Active
Credentials	MD
Entity	Individual
Enumeration date	01/27/2006
Last updated	09/11/2025 - About 9 months ago
Sole proprietor ¹	Not specified
Identifiers	ID License # M5240 WA Medicaid 8156473 Other P00165374 RAILROAD MEDICARE ID Other 71498 BLUE CROSS OF IDAHO ID Other 000010005909 REGENCE BS OF IDAHO WA Other 0192980 LABOR & INDUSTRIES
Hospital affiliation(s)	ST ANTHONY HOSPITAL - (Critical Access) 2801 ST ANTHONY WAY PENDLETON, OR 97801 TRI-STATE MEMORIAL HOSPITAL - (Critical Access) 1221 HIGHLAND AVENUE CLARKSTON, WA 99403

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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MARK W PETERSON, MD – NPI #1356312524Vascular & Interventional Radiology

Contact Information

Specialty

Vascular & Interventional Radiology

Diagnostic Radiology

NPI Profile & details for MARK W PETERSON · (Male)

Reviews for MARK W PETERSON

MARK W PETERSON, MD – NPI #1356312524
Vascular & Interventional Radiology