Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | K9757 | TX |
N | 207Q00000X | Family Doctor | K9757 | TX |
NPI | 1063520674 |
---|---|
Provider Name | Dr. Peter A Coldwell |
First Address | Fredericksburg, TX 78624-4471 |
Second Address | Fredericksburg, TX 78624-4471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 02/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042953201 | (05) | TX |
H15618 | (02) | TX |
K9757 | STATE MEDICAL LICENSE (01) | TX |