Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | DR.0048084 | CO |
N | 208200000X | Surgeon | 48084 | CO |
N | 208600000X | Surgeon | 48084 | CO |
NPI | 1073718680 |
---|---|
Provider Name | Dr. Peter T Kennealey |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 20/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83502882 | (05) | CO |