Provider Demographics
NPI:1750396628
Name:PETER L DY MD PA
Entity type:Organization
Organization Name:PETER L DY MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-283-8990
Mailing Address - Street 1:PO BOX 2946
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2946
Mailing Address - Country:US
Mailing Address - Phone:956-283-8990
Mailing Address - Fax:
Practice Address - Street 1:806 S CAGE BLVD STE B
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5961
Practice Address - Country:US
Practice Address - Phone:956-283-8990
Practice Address - Fax:956-283-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
TXK9055208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175442602Medicaid
TX175442601Medicaid
TX175442602Medicaid