Healthcare Provider Details

I. General information

NPI: 1528530326
Provider Name (Legal Business Name): PETER GEORGE DZIEWULSKI MBBS FRCS(PLAST)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UTMB 301 UNIVERSITY BOULEVARD 6.146 JOHN SEALY ANNEX
GALVESTON TX
77555-0001
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-0859
GB

V. Phone/Fax

Practice location:
  • Phone: 409-772-0504
  • Fax: 409-772-5611
Mailing address:
  • Phone: 409-772-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number46373
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: