Provider Demographics
NPI:1063472678
Name:TARBOX, PETER ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:TARBOX
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 1:5441 BABCOCK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3993
Mailing Address - Country:US
Mailing Address - Phone:210-641-1394
Mailing Address - Fax:210-561-2846
Practice Address - Street 1:5441 BABCOCK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3993
Practice Address - Country:US
Practice Address - Phone:210-641-1394
Practice Address - Fax:210-561-2846
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK63582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89232ZOtherBC/BS OF TEXAS
TX0313777-03Medicaid
TX8F8947Medicare PIN
TX89232ZOtherBC/BS OF TEXAS
TX0313777-01Medicaid