Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 12096 | MS |
NPI | 1134239171 |
---|---|
Provider Name | Mr. Peter J Casano |
First Address | Flowood, MS 39232-9303 |
Second Address | Flowood, MS 39232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 19/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00126164 | (05) | MS |
D89677 | (02) |