Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 12995R | LA |
NPI | 1215934740 |
---|---|
Provider Name | Dr. Peter James Bostick |
First Address | Baton Rouge, LA 70898-4782 |
Second Address | Baton Rouge, LA 70806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 02/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1563471 | (05) | LA |
2193181 | AETNA (01) | LA |
G22984 | (02) |