Individual
WALLACE CARY PETERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4101 TIGER LILY RD STE 100, LINCOLN, NE 68516-5587
(402) 420-7000
(402) 420-6969
Mailing address
4101 TIGER LILY RD STE 100, LINCOLN, NE 68516-5587
(402) 420-7000
(402) 420-6969
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
16442
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1242
MIDLANDS CHOICE
NE
05
—
200000870A
—
KS
01
—
32276
BCBS
NE
01
—
3600017
UHC
NE
Enumeration date
10/26/2005
Last updated
03/16/2024
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