Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 9337 | KY |
Y | 213EG0000X | General Practice | 9337 | KY |
NPI | 1003251455 |
---|---|
Provider Name | Ryan H Peace |
First Address | Elizabethtown, KY 42701-9114 |
Second Address | Elizabethtown, KY 42701-9114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 26/01/2017 |