Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 6584 | NE |
NPI | 1508839341 |
---|---|
Provider Name | Dr. Peter John Giannini |
First Address | Lincoln, NE 68508-1561 |
Second Address | Lincoln, NE 68583-0740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 18/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4505 | BCBS (01) | NE |
47078998500 | (05) | NE |
P00253376 | RAILROAD MEDICARE (01) | NE |
V06831 | (02) | NE |