Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME142493 | FL |
N | 2080A0000X | Adolescent Medicine | 147727 | NY |
NPI | 1245282060 |
---|---|
Provider Name | Peter Oppenheimer |
First Address | Plantation, FL 33324-3923 |
Second Address | Boynton Beach, FL 33426-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 26/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104820300 | (05) | FL |
B15753 | (02) | NY |