Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MB06567300 | NJ |
NPI | 1326017443 |
---|---|
Provider Name | Dr. Bruce William Peters |
First Address | Toms River, NJ 08753-2891 |
Second Address | Toms River, NJ 08753-2891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 16/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E92668 | (02) | NJ |