DR. GERALD DUDLEY PETERSON DPM NPI 1316983513

NPI Information

  • NPI: 1316983513
  • Provider Name: DR. GERALD DUDLEY PETERSON, DPM
  • Classification: Podiatrist - 213ES0103X
  • Specialization: Foot & Ankle Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1880 WILLAMETTE FALLS DR
    SUITE 111
    WEST LINN, OR
    ZIP 97068
  • Phone: (503) 657-1900

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NPI Details

DR. Gerald Dudley Peterson, DPM is a foot and ankle surgery podiatrist in West Linn, OR. DR. Gerald Dudley Peterson, DPM NPI is 1316983513. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1880 WILLAMETTE FALLS DR
SUITE 111
WEST LINN, OR
ZIP 97068-652
Phone: (503) 657-1900
Fax: (503) 657-7744

The NPI 1316983513 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 6/22/2006 and was last updated on 8/29/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213ES0103XPodiatristFoot & Ankle Surgery118OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1168161MEDICAIDOREGON
2T68008MEDICARE UPINOREGON
30915940001MEDICARE NSCOREGON
4930743342OTHEROREGONBCBS OF OREGON
5R0000SGBDJMEDICARE PINOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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