Individual
ROBERT LESTER PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 RIVERSIDE DR, SUITE III, WAUPACA, WI 54981-1983
(715) 258-8898
(715) 258-6980
Mailing address
900 RIVERSIDE DR, SUITE III, WAUPACA, WI 54981-1983
(715) 258-8898
(715) 258-6980
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19601
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19601
LICENSE
WI
05
—
31229100
—
WI
Enumeration date
12/30/2006
Last updated
07/08/2007
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