Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 290239 | NY |
NPI | 1023373230 |
---|---|
Provider Name | David L Peters |
First Address | Stony Brook, NY 11790-0989 |
Second Address | East Setauket, NY 11733-3487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 22/08/2017 |