Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD2013-0172 | NM |
NPI | 1487879987 |
---|---|
Provider Name | Peter C. Jeppson |
First Address | Albuquerque, NM 87106-2719 |
Second Address | Albuquerque, NM 87106-4374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 07/08/2013 |