Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD00048100 | WA |
NPI | 1033320817 |
---|---|
Provider Name | Neal J. Peterson |
First Address | Spokane, WA 99220-3649 |
Second Address | Spokane, WA 99202-1332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 15/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0222004 | L&I (01) | WA |
8484289 | (05) | WA |