Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 65024-20 | WI |
N | 207RA0201X | Internist - Allergy & Immunology | 65024-20 | WI |
NPI | 1053739714 |
---|---|
Provider Name | David L Peloza |
First Address | Madison, WI 53716-2257 |
Second Address | Madison, WI 53716-2257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 23/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053739714 | (05) | WI |