Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD07721 | RI |
NPI | 1023009404 |
---|---|
Provider Name | Dr. Peter C Brasch |
First Address | Smithfield, RI 02917-1826 |
Second Address | Smithfield, RI 02917-1826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 05/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F06680 | (02) |