1871683334 NPI number — DR. RUPERT AUGUSTUS PETERKIN M.D.

Table of content: DR. RUPERT AUGUSTUS PETERKIN M.D. (NPI 1871683334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871683334 NPI number — DR. RUPERT AUGUSTUS PETERKIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERKIN
Provider First Name:
RUPERT
Provider Middle Name:
AUGUSTUS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871683334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 8748
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE AMALIE
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-777-9696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9149 ESTATE THOMAS
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
ST. THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-777-9696
Provider Business Practice Location Address Fax Number:
340-715-6441
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  586 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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