Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 0101020902 | VA |
NPI | 1043289531 |
---|---|
Provider Name | Robert E Petres |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23235-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 30/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006220053 | (05) | VA |
B05366 | (02) |