Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 045315 | GA |
NPI | 1013004860 |
---|---|
Provider Name | Dr. John Stewart Peters |
First Address | Fort Rucker, AL 36362-5333 |
Second Address | Fort Rucker, AL 36362-5333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 15/05/2015 |