Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 26113 | IA |
NPI | 1871591966 |
---|---|
Provider Name | Dr. Peter Vincent Boesen |
First Address | Windsor Heights, IA 50311-1321 |
Second Address | Windsor Heights, IA 50311-1321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3058156 | (05) | IA |
D89646 | (02) |