Healthcare Provider Details

I. General information

NPI: 1275518912
Provider Name (Legal Business Name): DAVID W PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 BANDERA HWY
KERRVILLE TX
78028-9515
US

IV. Provider business mailing address

575 HILL COUNTRY DR STE 101
KERRVILLE TX
78028-6024
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-7762
  • Fax:
Mailing address:
  • Phone: 830-258-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number118496
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number04-28125
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberK9869
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK9869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: