MEDICARE: MR. JAMES PETERS R.NCST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	887	TX

General Provider Information

NPI Number	:	1376955286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES PETERS R.NCST

Provider Business Mailing Address
First Line	:	2401 FOUNTAIN VIEW DR
Second Line	:	SUITE 215B
City	:	HOUSTON
State	:	TX
Zip	:	77057-4827
Country	:	US
Telephone Number	:	832-415-3079
Fax Number	:	832-201-7555

Provider Business Practice Location Address
First Line	:	2401 FOUNTAIN VIEW DR
Second Line	:	SUITE 215B
City	:	HOUSTON
State	:	TX
Zip	:	77057-4827
Country	:	US
Telephone Number	:	832-415-3079
Fax Number	:	832-201-7555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	05/27/2014

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