Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 094467 | NY |
Y | 207VX0000X | Obstetrician | 42743 | AZ |
NPI | 1376527945 |
---|---|
Provider Name | G Michael Peters |
First Address | Scottsdale, AZ 85266-2274 |
Second Address | Scottsdale, AZ 85266-2274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
564135 | (05) | AZ |
C09394 | (02) |