Individual
DR. ROGER DWIGHT PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20 SOUTH WASHINGTON ST, ELKHORN, WI 53121
(262) 723-6668
Mailing address
5197 MAJORCA CLUB DRIVE, BOCA RATON, FL 33486
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15694-20
WI
Other
Enumeration date
05/23/2012
Last updated
05/23/2012
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