Provider Demographics
NPI:1942484506
Name:JOHN C PEYTON MD
Entity Type:Organization
Organization Name:JOHN C PEYTON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-683-1825
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-7027
Mailing Address - Country:US
Mailing Address - Phone:903-683-1825
Mailing Address - Fax:903-683-1556
Practice Address - Street 1:1400 HWY 84 WEST
Practice Address - Street 2:SUITE 6
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-7027
Practice Address - Country:US
Practice Address - Phone:903-683-1825
Practice Address - Fax:903-683-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00758GOtherBCBS
TXB90476Medicare UPIN
TX00758GOtherBCBS