Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101055079 | VA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 0101055079 | VA |
NPI | 1174549968 |
---|---|
Provider Name | Peter Takacs |
First Address | Norfolk, VA 23501-0936 |
Second Address | Norfolk, VA 23507-1914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 21/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174549968 | (05) | NC |
1174549968 | (05) | VA |
G87392 | (02) | FL |