Provider Demographics
NPI:1811690035
Name:GEORGEI, PETER NADY ISHAK
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:NADY ISHAK
Last Name:GEORGEI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 SOUTHWESTERN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8418
Mailing Address - Country:US
Mailing Address - Phone:903-240-8590
Mailing Address - Fax:
Practice Address - Street 1:3802 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4149
Practice Address - Country:US
Practice Address - Phone:214-443-5160
Practice Address - Fax:214-443-0741
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43550390200000X
TX73768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program