Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 34.009548 | OH |
Y | 207RC0000X | Internist - Cardiovascular Disease | 4577 | AZ |
NPI | 1023167384 |
---|---|
Provider Name | Craig Michael Peters |
First Address | Flagstaff, AZ 86001-3118 |
Second Address | Flagstaff, AZ 86001-3118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 21/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210080 | (05) | AZ |