Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD00035886 | WA |
NPI | 1245391416 |
---|---|
Provider Name | Dr. Peter H. Hertz |
First Address | Swansea, MA 02777-4566 |
Second Address | Swansea, MA 02777-4566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 05/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H12403 | (02) |