Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G74506 | CA |
NPI | 1003980566 |
---|---|
Provider Name | Dr. Peter Bernard Albert Pappas |
First Address | Santa Rosa, CA 95404-4312 |
Second Address | Santa Rosa, CA 95404-4312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G745060 | (05) | CA |
680468716 | TAX ID (01) | CA |
F37480 | (02) | CA |