Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 041491 | GA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 041491 | GA |
NPI | 1225193303 |
---|---|
Provider Name | Robert Peter Styperek |
First Address | Rome, GA 30165-1369 |
Second Address | Rome, GA 30165-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 05/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000925834A | (05) | GA |
H58226 | (02) |