Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G84728 | CA |
NPI | 1093717951 |
---|---|
Provider Name | Dr. Robert Kay Peterson |
First Address | Vacaville, CA 95687-4172 |
Second Address | Vacaville, CA 95687-4172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 15/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G50858 | (02) |