Individual
PETER STEVAN JEROME
Active
Individual
PETER STEVAN JEROME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
12731
ND
207RP1001X
Pulmonary Disease Physician
23793
WI
207RP1001X
Pulmonary Disease Physician
51376
MN
207RP1001X
Pulmonary Disease Physician
M-12784
ID
207RP1001X
Pulmonary Disease Physician
Primary
P4321
TX
207RS0012X
Sleep Medicine (Internal Medicine) Physician
M-12784
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31692500
—
WI
05
—
393948001
—
TX
05
—
ENROLLED
—
IA
01
—
P00849680
RAILROAD MEDICARE
MN
01
—
P02137176
MEDICARE RAILROAD
TX
Enumeration date
06/14/2005
Last updated
01/11/2021
Update your record
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