Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 31935 | CO |
N | 207RG0100X | Gastroenterologist | R3E28 | MO |
NPI | 1013987965 |
---|---|
Provider Name | Dr. Peter R Mcnally |
First Address | Fort Carson, CO 80913-4603 |
Second Address | Ft Carson, CO 80913-4604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
88234347 | (05) | CO |
DAD000 | (02) |