Provider Demographics
NPI:1518148865
Name:PETER S. FORNOS M.D., P.A.
Entity Type:Organization
Organization Name:PETER S. FORNOS M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:FORNOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-227-7293
Mailing Address - Street 1:311 CAMDEN ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2012
Mailing Address - Country:US
Mailing Address - Phone:210-227-7293
Mailing Address - Fax:210-227-7050
Practice Address - Street 1:311 CAMDEN ST
Practice Address - Street 2:SUITE 504
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2012
Practice Address - Country:US
Practice Address - Phone:210-227-7293
Practice Address - Fax:210-227-7050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER S. FORNOS M.D., PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-15
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2936207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082436901Medicaid
TX00F24EMedicare PIN
TX082436901Medicaid