Provider Demographics
NPI:1669708996
Name:DR SUPPLY
Entity type:Organization
Organization Name:DR SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-846-9502
Mailing Address - Street 1:2601 COUNTY ROAD 415
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-9061
Mailing Address - Country:US
Mailing Address - Phone:817-846-9502
Mailing Address - Fax:817-645-4550
Practice Address - Street 1:2601 COUNTY ROAD 415
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-9061
Practice Address - Country:US
Practice Address - Phone:817-846-9502
Practice Address - Fax:817-645-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0091228332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies