Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 04-31068 | KS |
NPI | 1285741231 |
---|---|
Provider Name | Peter James Seberger |
First Address | Wichita, KS 67214-4436 |
Second Address | Wichita, KS 67214-4436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 27/10/2011 |