Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003566 | VA |
NPI | 1184804791 |
---|---|
Provider Name | Peter P Anderson |
First Address | Newport News, VA 23602-4479 |
Second Address | Newport News, VA 23602-4479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2007 |
Last Update Date | 10/12/2007 |