Individual
MR. LARS E PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
255 N 30TH ST, LARAMIE, WY 82072-5140
(307) 742-2141
Mailing address
320 S 7TH ST, LARAMIE, WY 82070-3822
(307) 399-2883
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6962A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119117900
—
WY
Enumeration date
09/03/2006
Last updated
10/31/2012
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