Healthcare Provider Details

I. General information

NPI: 1851543201
Provider Name (Legal Business Name): PETER GAMES L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6003 OVERLAND RD SUITE 203
BOISE ID
83709-3073
US

IV. Provider business mailing address

6003 OVERLAND RD SUITE 203
BOISE ID
83709-3073
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-1455
  • Fax:
Mailing address:
  • Phone: 208-377-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU-222
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: