Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 0006958 | VT |
Y | 207N00000X | Dermatologist | 82076958 | NH |
NPI | 1033289020 |
---|---|
Provider Name | Jose Emilio Peraza |
First Address | Claremont, NH 03743-2636 |
Second Address | Claremont, NH 03743-2636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 01/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP9149825 | DEA (01) | |
C65233 | (02) |