Provider Demographics
NPI:1023549870
Name:PETER, TONY (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:PETER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 WARREN PKWY STE 504
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4253
Mailing Address - Country:US
Mailing Address - Phone:972-596-4005
Mailing Address - Fax:972-985-1253
Practice Address - Street 1:8380 WARREN PKWY STE 504
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4253
Practice Address - Country:US
Practice Address - Phone:972-596-4005
Practice Address - Fax:972-985-1253
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT5433207Y00000X
TX125.071145207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program