Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | M4807 | ID |
NPI | 1083704332 |
---|---|
Provider Name | Peter Christopher Jones |
First Address | Coeur D Alene, ID 83814-2639 |
Second Address | Coeur D Alene, ID 83814-2639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 27/04/2009 |