Individual
MR. JOE R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6161
Mailing address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6161
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2825-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174802805
—
WI
Enumeration date
08/11/2011
Last updated
11/11/2020
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