Provider Demographics
NPI:1952401358
Name:PEYTON, SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PEYTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 E SANDY LAKE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5786
Mailing Address - Country:US
Mailing Address - Phone:469-671-3337
Mailing Address - Fax:469-671-3338
Practice Address - Street 1:546 E SANDY LAKE RD STE 210
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5786
Practice Address - Country:US
Practice Address - Phone:469-671-3337
Practice Address - Fax:469-671-3338
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047125202Medicaid
TXK3392OtherSTATE LICENSE
TX047125203Medicaid
TX047125204Medicaid
TX8L8944Medicare PIN
TX8L8942Medicare PIN
TX047125202Medicaid
TXG48990Medicare UPIN