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General NPI Number Information
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NPI Number | 1518041615
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Entity Type | Individual
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Provider Name | PETER HEDERA MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 220 ABRAHAM FLEXNER WAY FL 6
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City | LOUISVILLE
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State | KY
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Zip | 40202-3826
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Country | US
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Telephone | 502-582-7654
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Fax | 502-588-7563
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Provider Business Mailing Address
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Address Line | PO BOX 909
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City | LOUISVILLE
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State | KY
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Zip | 40201-0909
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Country | US
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Telephone | 502-588-0328
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Fax | 25-887-5635
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MD36171
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD36171
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 53689
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License Number State | KY
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