Provider Demographics
NPI:1609320464
Name:DR. PEPERMINTWALA PLLC
Entity Type:Organization
Organization Name:DR. PEPERMINTWALA PLLC
Other - Org Name:WEST TEXAS PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMSUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPERMINTWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-218-9920
Mailing Address - Street 1:4214 ANDREWS HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4813
Mailing Address - Country:US
Mailing Address - Phone:432-218-9920
Mailing Address - Fax:432-218-9356
Practice Address - Street 1:4214 ANDREWS HWY STE 108
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4813
Practice Address - Country:US
Practice Address - Phone:432-218-9920
Practice Address - Fax:432-218-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK45252084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty