Individual
BRUCE P. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5000 PRAIRIE ROSE DR, ROSCOE, IL 61073-7792
(815) 971-2000
Mailing address
5000 PRAIRIE ROSE DR, ROSCOE, IL 61073-7792
(815) 971-2000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-053478
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053478
—
IL
Enumeration date
08/30/2006
Last updated
01/29/2010
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