Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | O-0366 | ID |
NPI | 1073529202 |
---|---|
Provider Name | Christopher C Peine |
First Address | Eagle, ID 83616-6552 |
Second Address | Eagle, ID 83616-6552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 14/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I13546 | (02) | ID |