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Individual
WALLACE CARY PETERSON JR.
Active
Individual
WALLACE CARY PETERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
16442
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1242
MIDLANDS CHOICE
NE
05
—
200000870A
—
KS
01
—
32276
BCBS
NE
01
—
3600017
UHC
NE
Enumeration date
10/26/2005
Last updated
03/16/2024
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