Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | J7624 | TX |
NPI | 1053374587 |
---|---|
Provider Name | Dr. Arvind V Peddada |
First Address | Dallas, TX 75373-3424 |
Second Address | Sherman, TX 75092-7069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 04/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F91597 | (02) |