Provider Demographics
NPI:1508840588
Name:PERRETTA, PETER TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:TIMOTHY
Last Name:PERRETTA
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 1:45 N.E. LOOP 410N #900
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:210-375-7790
Mailing Address - Fax:
Practice Address - Street 1:45 NE LOOP 410
Practice Address - Street 2:SUITE 900
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5832
Practice Address - Country:US
Practice Address - Phone:210-375-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4367207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1361974-02Medicaid
TX85810FMedicare ID - Type UnspecifiedMEDICARE
TX1361974-02Medicaid