Individual
ROBERT PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
707 ASH STREET, SPOONER, WI 54801
(715) 635-2151
Mailing address
707 ASH STREET, SPOONER, WI 54801
(715) 635-2151
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9873
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0117135
MEDICA
MN
05
—
110533700
—
MN
01
—
115317
UCARE
MN
01
—
209L9PE
BCBS
MN
01
—
410849339 56001 G011
CHAMPUS
—
01
—
HP20659
HEALTH PARTNERS
MN
01
—
NA2951011331
PREFERRED ONE
MN
Enumeration date
01/10/2006
Last updated
09/24/2008
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