Individual
THOMAS L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 W STOUT ST, RICE LAKE, WI 54868-5000
(715) 236-8100
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
WI26696
WI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
WI26696
WI
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
WI26696
WI
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
WI26696
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30653800
—
WI
Enumeration date
05/22/2006
Last updated
02/15/2010
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