Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 9653 | KY |
N | 213EG0000X | General Practice | 9653 | KY |
Y | 1223P0700X | Prosthodontist | 12013046A | IN |
NPI | 1255708723 |
---|---|
Provider Name | Dr. Peter Wulff |
First Address | Evansville, IN 47710-1782 |
Second Address | Evansville, IN 47710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 20/11/2018 |