Provider Demographics
NPI:1083702930
Name:PEET, JOHN VERNON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VERNON
Last Name:PEET
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 1:4015 I 45 N
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4901
Mailing Address - Country:US
Mailing Address - Phone:936-760-7864
Mailing Address - Fax:
Practice Address - Street 1:4015 I 45 N
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4901
Practice Address - Country:US
Practice Address - Phone:936-760-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099343802Medicaid
TXC20366Medicare UPIN
TX099343802Medicaid
GA12900523Medicare PIN