Provider Demographics
NPI:1932128048
Name:PATRICK H. PETERS, JR., M.D., P.A.
Entity Type:Organization
Organization Name:PATRICK H. PETERS, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:H
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-521-7676
Mailing Address - Street 1:6547 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1434
Mailing Address - Country:US
Mailing Address - Phone:210-521-7676
Mailing Address - Fax:210-521-7690
Practice Address - Street 1:6547 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1434
Practice Address - Country:US
Practice Address - Phone:210-521-7676
Practice Address - Fax:210-521-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0013BHMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER