Provider Demographics
NPI:1114070166
Name:JASON EDWARD PETERS, M.D., P.A.
Entity Type:Organization
Organization Name:JASON EDWARD PETERS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-423-9111
Mailing Address - Street 1:2106 HALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8408
Mailing Address - Country:US
Mailing Address - Phone:956-423-9111
Mailing Address - Fax:956-423-9273
Practice Address - Street 1:2106 HALE AVENUE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8408
Practice Address - Country:US
Practice Address - Phone:956-423-9111
Practice Address - Fax:956-423-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0024PSOtherBLUE CROSS
TX00Y006Medicare PIN