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Individual
EDWARD A PELTON
Active
Individual
EDWARD A PELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18841
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00081
BLUE SHIELD PROVIDER NUMB
NE
01
—
18841
STATE LICENSE NUMBER
NE
Enumeration date
11/21/2005
Last updated
01/26/2011
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