Provider Demographics
NPI:1790906337
Name:ALIVIZATOS, PETER ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALEXANDER
Last Name:ALIVIZATOS
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 1:3600 GASTON AVENUE
Mailing Address - Street 2:404 BARNETT TOWER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1804
Mailing Address - Country:US
Mailing Address - Phone:214-824-6718
Mailing Address - Fax:214-821-3760
Practice Address - Street 1:3600 GASTON AVENUE
Practice Address - Street 2:404 BARNETT TOWER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1804
Practice Address - Country:US
Practice Address - Phone:214-824-6718
Practice Address - Fax:214-821-3760
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7614146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FT79Medicare ID - Type Unspecified
TXC12710Medicare UPIN