Provider Demographics
NPI:1760736821
Name:WOODLANDS GYNECOLOGY & AESTHETICS
Entity Type:Organization
Organization Name:WOODLANDS GYNECOLOGY & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-443-8920
Mailing Address - Street 1:17350 ST LUKES WAY
Mailing Address - Street 2:SUITE 390
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4100
Mailing Address - Country:US
Mailing Address - Phone:936-443-8920
Mailing Address - Fax:
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:SUITE 390
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4100
Practice Address - Country:US
Practice Address - Phone:936-443-8920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2981207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty