Provider Demographics
NPI:1700847944
Name:SANNI-THOMAS, PETER (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SANNI-THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 W. TITAN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389
Mailing Address - Country:US
Mailing Address - Phone:832-534-8465
Mailing Address - Fax:
Practice Address - Street 1:601 W SANFORD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-7086
Practice Address - Country:US
Practice Address - Phone:817-920-6300
Practice Address - Fax:817-276-9797
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5124207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156535002Medicaid
TXH79392Medicare UPIN
TX8D9274Medicare ID - Type Unspecified