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1215030119 NPI number — CHRISTOPHER WARREN PETERS MED ATC LAT

NPI Number: 1215030119
Health Care Provider/Practitioner: CHRISTOPHER WARREN PETERS MED ATC LAT

Information about “1215030119” NPI (CHRISTOPHER WARREN PETERS MED ATC LAT) exists in 1215030119 in HTML format HTML  |  1215030119 in plain Text format TXT  |  1215030119 in PDF (Portable Document Format) PDF  |  1215030119 in an XML format XML  formats.

NPI Number : 1215030119 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215030119",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERS",
    "FirstName": "CHRISTOPHER",
    "MiddleName": "WARREN",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MED ATC LAT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PETERS",
    "OtherFirstName": "CHRIS",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MED ATC LAT",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "4112 52ND STREET CT W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRADENTON",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34209-6758",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "941-714-7300",
    "MailingAddressFaxNumber": "941-741-3443",
    "FirstLinePracticeLocationAddress": "902 33RD ST. CT. WEST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRADENTON",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34205",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "941-714-7300",
    "PracticeLocationAddressFaxNumber": "941-741-3443",
    "EnumerationDate": "09/06/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "AL 1918",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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