Provider Demographics
NPI:1669464822
Name:SPEICHER, PETER JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:SPEICHER
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 1:730 N. MAIN AVE.
Mailing Address - Street 2:STE. #418
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1116
Mailing Address - Country:US
Mailing Address - Phone:210-223-9707
Mailing Address - Fax:210-224-0416
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:STE. 418
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1116
Practice Address - Country:US
Practice Address - Phone:210-223-9707
Practice Address - Fax:210-224-0416
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7830207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120609604Medicaid
TX4259310001Medicare NSC
TX120609604Medicaid