Provider Demographics
NPI:1710688247
Name:CIBOLO CREEK ALLERGY PA
Entity Type:Organization
Organization Name:CIBOLO CREEK ALLERGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-997-5559
Mailing Address - Street 1:110 E LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4450
Mailing Address - Country:US
Mailing Address - Phone:830-997-5559
Mailing Address - Fax:830-997-5558
Practice Address - Street 1:109 YOALANA, SUITE 110
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-997-5559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty