Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | DO2840 | NV |
NPI | 1558786723 |
---|---|
Provider Name | Kurt Robert Peterson |
First Address | Las Vegas, NV 89118-1896 |
Second Address | Las Vegas, NV 89118-1896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2014 |
Last Update Date | 17/09/2021 |