Provider Demographics
NPI:1154306603
Name:PETROS, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:PETROS
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:PO BOX 3806
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3806
Mailing Address - Country:US
Mailing Address - Phone:361-885-0010
Mailing Address - Fax:361-885-0001
Practice Address - Street 1:613 ELIZABETH ST
Practice Address - Street 2:SUITE 704
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2220
Practice Address - Country:US
Practice Address - Phone:361-885-0010
Practice Address - Fax:361-885-0001
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0629207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE96175Medicare UPIN
TX391100ZMFSMedicare PIN
TX86385JMedicare ID - Type Unspecified