Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | R4E26 | MO |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | R4E26 | MO |
NPI | 1154322766 |
---|---|
Provider Name | Peter K Buchert |
First Address | Columbia, MO 65201-7199 |
Second Address | Columbia, MO 65201-7199 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 19/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202066700 | (05) | MO |
A12685 | (02) | MO |