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Individual
PETER KENNETH BOTT
Active
Individual
PETER KENNETH BOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
054356
TX
367500000X
Certified Registered Nurse Anesthetist
ARNP 2853722
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185859901
—
TX
05
—
185859902
—
TX
05
—
305301600
—
FL
01
—
87063U
BLUE CROSS BLUE SHIELD
TX
01
—
88598U
BLUE CROSS BLUE SHIELD
TX
01
—
G3301
BLUE CROSS
FL
01
—
P00394595
MEDICARE RAILROAD
TX
01
—
P00671245
MEDICARE RAILROAD
TX
Enumeration date
03/23/2006
Last updated
01/19/2011
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