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General NPI Number Information
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NPI Number | 1992793392
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Entity Type | Individual
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Provider Name | STANLEY E PETERSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 426 MCMILLEN ST
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1996
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Country | US
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Telephone | 920-563-7888
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Fax | 920-563-7741
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Provider Business Mailing Address
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Address Line | 426 MCMILLEN ST
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1996
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Country | US
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Telephone | 920-563-7888
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Fax | 920-563-7741
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 22907 020
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License Number State | WI
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