Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 2005029313 | MO |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 57030 | WI |
NPI | 1013965755 |
---|---|
Provider Name | Dr. Charles Peters |
First Address | Eau Claire, WI 54702-1510 |
Second Address | Onalaska, WI 54650-8679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 10/02/2021 |