Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 35038788 | OH |
NPI | 1023039310 |
---|---|
Provider Name | Peter H Greenwalt |
First Address | Westlake, OH 44145-1493 |
Second Address | Westlake, OH 44145-1493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 20/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
347431 | (05) | OH |
C01287 | (02) | OH |