Provider Demographics
NPI:1720157365
Name:PETERS, CRAIG ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ANDREW
Last Name:PETERS
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 1:1935 MEDICAL DISTRICT DRIVE
Mailing Address - Street 2:MAIL STOP F4.04
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235
Mailing Address - Country:US
Mailing Address - Phone:214-456-4677
Mailing Address - Fax:214-456-8803
Practice Address - Street 1:2350 N. STEMMONS FREEWAY
Practice Address - Street 2:SUITE F4300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207
Practice Address - Country:US
Practice Address - Phone:214-456-2444
Practice Address - Fax:214-456-2497
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239362208800000X
TXQ59012088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology