Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 42106 | GA |
NPI | 1043215759 |
---|---|
Provider Name | Scott H Petermann |
First Address | Valdosta, GA 31602-6921 |
Second Address | Valdosta, GA 31602-6921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 06/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008244425C | (05) | GA |
G98410 | (02) | GA |