Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME37959 | FL |
NPI | 1205850385 |
---|---|
Provider Name | Dr. Peter Stu Katz |
First Address | Boynton Beach, FL 33436-4642 |
Second Address | Boynton Beach, FL 33436-4642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 26/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278557900 | (05) | FL |
E94425 | (02) | FL |