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General NPI Number Information
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NPI Number | 1841233475
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Entity Type | Individual
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Provider Name | PETER L. HERCULES MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 427 HWY 51 NORTH
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City | BROOKHAVEN
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State | MS
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Zip | 39601-2600
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Country | US
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Telephone | 601-892-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD. SUITE 201
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City | LAFAYETTE
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State | LA
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Zip | 70508
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Country | US
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Telephone | 800-893-9698
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 293334
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 293334
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 16013
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License Number State | MS
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