Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 01032191A | IN |
NPI | 1043224512 |
---|---|
Provider Name | Dr. John Gerard Peters |
First Address | Indianapolis, IN 46280-1393 |
Second Address | Indianapolis, IN 46280-1393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 14/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200081250A | (05) | IN |
C25656 | (02) |