| Doctor Name: | DR. PETER KING TIERNAN |
| NPI Number: | 1902819550 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD,MPH, LTC USAFR |
| License Number: | MD2006-0119 |
| Business Practice Address: | 7920 Carmel Ave Ne Ste C Albuquerque, NM - 871222967 |
| Business Phone Number: | 5053444959 |
| Business Fax Number: | |
| Mailing Address: | 7920 Carmel Ave Ne Ste C, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871222967 |
| Phone Number: | 5053444959 |
| Fax Number: | |
| NPI Enumeration Date: | 08/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD2006-0119 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |