Provider Demographics
NPI:1639171770
Name:LEDOUX, PETER R (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:R
Last Name:LEDOUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29130
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0130
Mailing Address - Country:US
Mailing Address - Phone:210-692-1181
Mailing Address - Fax:210-692-7584
Practice Address - Street 1:9635 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1512
Practice Address - Country:US
Practice Address - Phone:210-692-1181
Practice Address - Fax:210-692-7584
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ53832086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85W581Medicare PIN
F09657Medicare UPIN