Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME95971 | FL |
N | 208600000X | Surgeon | ME95971 | FL |
Y | 208200000X | Surgeon | Q2367 | TX |
Y | 208600000X | Surgeon | Q2367 | TX |
N | 2086S0102X | Surgical Critical Care | Q2367 | TX |
N | 2086X0206X | Surgical Oncologist | Q2367 | TX |
NPI | 1164538914 |
---|---|
Provider Name | Darren L Peterson |
First Address | Amarillo, TX 79106-1708 |
Second Address | Amarillo, TX 79106-1786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 31/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200565240 A | (05) | OK |
2768488-00 | (05) | FL |
32522746 | (05) | NM |
342173701 | (05) | TX |
342173702 | (05) | TX |
40181D | MEDICARE HCP GROUP (01) | FL |
454214962A | (05) | GA |
I71557 | (02) | FL |