Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 6902 | NE |
Y | 1223P0700X | Prosthodontist | 6902 | NE |
NPI | 1104131572 |
---|---|
Provider Name | Stephen Benjamin Peterman |
First Address | Tripler Amc, HI 96859-5000 |
Second Address | Tripler Amc, HI 96859-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 26/08/2016 |