Healthcare Provider Details

I. General information

NPI: 1376955286
Provider Name (Legal Business Name): JAMES PETERS R.NCST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 FOUNTAIN VIEW DR SUITE 215B
HOUSTON TX
77057-4827
US

IV. Provider business mailing address

2401 FOUNTAIN VIEW DR SUITE 215B
HOUSTON TX
77057-4827
US

V. Phone/Fax

Practice location:
  • Phone: 832-415-3079
  • Fax: 832-201-7555
Mailing address:
  • Phone: 832-415-3079
  • Fax: 832-201-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: