Provider Demographics
NPI:1639145667
Name:FORNOS, PETER S (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:FORNOS
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 1:311 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2936207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011238903Medicaid
TX082436901Medicaid
TXP01286150OtherRAILROAD MEDICARE
TX312736YP78Medicare PIN
TX011238903Medicaid
TX082436901Medicaid