Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | SC001923-L | PA |
NPI | 1073577995 |
---|---|
Provider Name | Dr. C. Brian Peffer |
First Address | Camp Hill, PA 17011-2250 |
Second Address | Camp Hill, PA 17011-2250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 25/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01122801 | CAPITAL BLUE CROSS (01) | PA |
093143 | HIGHMARK BLUE SHIELD (01) | PA |
T28463 | (02) |