Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | G3686 | TX |
NPI | 1235109026 |
---|---|
Provider Name | Mark T. Peters |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 07/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137685171 | (05) | TX |
137685711 | (05) | TX |
137685713 | (05) | TX |
137685714 | (05) | TX |
137685715 | (05) | TX |
137685716 | (05) | TX |
137685718 | (05) | TX |
8F9143 | (05) | TX |
B98992 | (02) |