Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G70622 | CA |
NPI | 1053300806 |
---|---|
Provider Name | Dr. Peter L Kopelson |
First Address | Beverly Hills, CA 90210-4532 |
Second Address | Beverly Hills, CA 90210-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 20/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F59594 | (02) | |
W18106 | GROUP ID (01) | CA |