Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | D0076921 | MD |
Y | 207P00000X | Emergency Physician | MD041925 | DC |
NPI | 1013150606 |
---|---|
Provider Name | Dr. Peter Jan Bluvas JR. |
First Address | Rockville, MD 20853-3201 |
Second Address | Gaithersburg, MD 20879-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2009 |
Last Update Date | 25/06/2021 |