Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CH5374 | FL |
NPI | 1518181833 |
---|---|
Provider Name | Mr. Drew Leland Peterson |
First Address | Fort Pierce, FL 34949-3518 |
Second Address | Fort Pierce, FL 34949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |