Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 29216 | MS |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 29216 | MS |
NPI | 1114314481 |
---|---|
Provider Name | Peter Henning |
First Address | Memphis, TN 38119-5754 |
Second Address | Memphis, TN 38120-4023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1R5931 | MS MEDICARE (01) | MS |
29216 | MS LICENSE (01) | MS |
64018 | TN LICENSE (01) | TN |
T20468A | TN MEDICARE (01) | TN |