Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G45381 | CA |
NPI | 1013071828 |
---|---|
Provider Name | Dr. Grant Wilson Peters |
First Address | Bakersfield, CA 93386-6037 |
Second Address | Bakersfield, CA 93301-5104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |