Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 29712 | KY |
NPI | 1013900984 |
---|---|
Provider Name | Peter S Lansing |
First Address | Louisville, KY 40232-4748 |
Second Address | Louisville, KY 40207-4605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 10/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64297120 | (05) | KY |
G37084 | (02) | KY |