Individual
GAVIN PAUL PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
107 E HIGHLAND DR, OCONTO FALLS, WI 54154-1002
(920) 846-3092
(920) 846-8313
Mailing address
PO BOX 1866, GREEN BAY, WI 54305-1866
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5323
WI
363AM0700X
Medical Physician Assistant
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—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1172149
NATIONAL COMM ON CERTIFICATION OF PHYSICIAN ASSISTANCES
—
Enumeration date
03/03/2020
Last updated
08/28/2025
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