1215030119 NPI number — MR. CHRISTOPHER WARREN PETERS MED ATC LAT

Table of content: (NPI 1689375982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215030119 NPI number — MR. CHRISTOPHER WARREN PETERS MED ATC LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERS
Provider First Name:
CHRISTOPHER
Provider Middle Name:
WARREN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MED ATC LAT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERS
Provider Other First Name:
CHRIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MED ATC LAT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215030119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4112 52ND STREET CT W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34209-6758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-714-7300
Provider Business Mailing Address Fax Number:
941-741-3443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 33RD ST. CT. WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-714-7300
Provider Business Practice Location Address Fax Number:
941-741-3443
Provider Enumeration Date:
09/06/2006

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: 2255A2300X , with the licence number:  AL 1918 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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