Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35.132291 | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35.132291 | OH |
NPI | 1225395361 |
---|---|
Provider Name | Nicholas J Peters |
First Address | Bellefontaine, OH 43311-2382 |
Second Address | Bellefontaine, OH 43311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0281123 | (05) | OH |