Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 3815 | AZ |
NPI | 1003813643 |
---|---|
Provider Name | Gerald D. Peiser |
First Address | Phoenix, AZ 85038-9211 |
Second Address | Phoenix, AZ 85008-4503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 05/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H79432 | (02) | AZ |