Provider Demographics
NPI:1215647888
Name:PRICE, PETER MATTHEW
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MATTHEW
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 CHERRY MILL CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3858
Mailing Address - Country:US
Mailing Address - Phone:817-707-7511
Mailing Address - Fax:
Practice Address - Street 1:4117 CHERRY MILL CT
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3858
Practice Address - Country:US
Practice Address - Phone:817-707-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46260655172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver