Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 22023 | TX |
NPI | 1063748614 |
---|---|
Provider Name | Dr. Brian Jay Peters |
First Address | Maxwell, TX 78656-4363 |
Second Address | Austin, TX 78750-1831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2009 |
Last Update Date | 02/11/2009 |