Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 11855 | TX |
NPI | 1679857858 |
---|---|
Provider Name | Dr. Zachary Adam Petter |
First Address | Waco, TX 76702 |
Second Address | Waco, TX 76702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2011 |
Last Update Date | 05/10/2011 |