Peterson, Bruce P.
Peterson, Bruce P. is an individual health care provider with primary practice located at 5000 Prairie Rose Dr , Roscoe IL 61073-7792. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Peterson, Bruce P. can be contacted via phone (815) 971-2000.Contact Information
Primary practice address
5000 Prairie Rose Dr
Roscoe IL 61073-7792
Phone: (815) 971-2000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 036-053478 | Illinois |
Profile Details
| NPI number | 1821108010 |
|---|---|
| LBN Legal business name | Peterson, Bruce P. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2006 |
| Last updated | Jan 29th, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821108010 | NPPES |
| Illinois | MEDICAID | 036053478 |
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