Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME64466 | FL |
NPI | 1043357122 |
---|---|
Provider Name | Dr. Peter Teng |
First Address | Hialeah, FL 33013-3812 |
Second Address | Hialeah, FL 33013-3812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 21/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
374682800 | (05) | FL |
BT3721811 | DEA (01) | FL |