Provider Demographics
NPI:1629044144
Name:DEFRANK, PETER R (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:DEFRANK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 ALTO CARO DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4303
Mailing Address - Country:US
Mailing Address - Phone:214-866-5313
Mailing Address - Fax:972-947-3976
Practice Address - Street 1:7709 ALTO CARO DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4303
Practice Address - Country:US
Practice Address - Phone:214-866-5313
Practice Address - Fax:972-947-3976
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0866213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01242887OtherRAILROAD MEDICARE
TX112216007Medicaid
TX112216009Medicaid
TX75-2018765OtherTAX ID
TX112216008Medicaid
TX112216010Medicaid
TX75-2018765OtherTAX ID
TX112216010Medicaid
TX112216008Medicaid
TX311436YPT7Medicare PIN
TX00G409Medicare ID - Type Unspecified
TX311436YPREMedicare PIN