Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME0043058 | FL |
NPI | 1043245665 |
---|---|
Provider Name | Mr. Peter Robert Dumas |
First Address | Venice, FL 34285-4520 |
Second Address | Venice, FL 34285-7163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 30/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D51452 | (02) |