Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 71982 | WI |
N | 207X00000X | Orthopaedic Surgeon | A124381 | CA |
N | 207X00000X | Orthopaedic Surgeon | R-8448 | IA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 13271 | ND |
NPI | 1245491182 |
---|---|
Provider Name | Dr. Jonathan Bradley Peterson |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 06/12/2019 |