Provider Demographics
NPI:1821022401
Name:DAMICO, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:DAMICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:J
Other - Last Name:DAMICO MD PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6010 CURZON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116
Mailing Address - Country:US
Mailing Address - Phone:817-738-9268
Mailing Address - Fax:817-738-9271
Practice Address - Street 1:6010 CURZON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5531
Practice Address - Country:US
Practice Address - Phone:817-738-9268
Practice Address - Fax:817-738-9271
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080018812OtherRAILROAD MEDICARE
TX080018812OtherRAILROAD MEDICARE
TX378340Medicare PIN