Provider Demographics
NPI:1356498299
Name:PETERS, PAUL C JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:PETERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 N CENTRAL EXPY STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0805
Mailing Address - Country:US
Mailing Address - Phone:214-220-2468
Mailing Address - Fax:214-720-1982
Practice Address - Street 1:9301 N CENTRAL EXPY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0805
Practice Address - Country:US
Practice Address - Phone:214-220-2468
Practice Address - Fax:214-720-1982
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101043615207X00000X
TXG8339207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200014314OtherRAILROAD MEDICARE
TX103191601Medicaid
TX103191601Medicaid
TXC20451Medicare UPIN