Provider Demographics
NPI:1841300431
Name:STANFIELD, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:STANFIELD
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 1:12407 WESTELLA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3919
Mailing Address - Country:US
Mailing Address - Phone:281-804-6984
Mailing Address - Fax:281-589-0006
Practice Address - Street 1:610 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:TX
Practice Address - Zip Code:77562-4205
Practice Address - Country:US
Practice Address - Phone:281-843-2441
Practice Address - Fax:281-843-2450
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF71332084P0800X, 208D00000X
CA7695208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21552Medicare UPIN
TX8C8054Medicare PIN