Provider Demographics
NPI:1497760375
Name:PETER L DY MD PA
Entity Type:Organization
Organization Name:PETER L DY MD PA
Other - Org Name:HEAVENLY CHILDRENS PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-283-8990
Mailing Address - Street 1:PO BOX 2946
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2946
Mailing Address - Country:US
Mailing Address - Phone:956-519-9511
Mailing Address - Fax:956-519-9411
Practice Address - Street 1:2310 E EXPWY 83
Practice Address - Street 2:SUITE 7
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-519-9511
Practice Address - Fax:956-519-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175442601Medicaid
TX175442601Medicaid