Individual
PETER VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1970 N HIGHWAY 190, SUITE 100, COVINGTON, LA 70433-5158
(985) 867-8585
(985) 867-3644
Mailing address
PO BOX 3370, COVINGTON, LA 70434-3370
(985) 867-8585
(985) 867-3644
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD.203954
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02774204
—
MS
05
—
50962
—
LA
Enumeration date
05/25/2007
Last updated
12/23/2014
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