Healthcare Provider Details

I. General information

NPI: 1356635049
Provider Name (Legal Business Name): PETER D CAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 I 30
MESQUITE TX
75150-6905
US

IV. Provider business mailing address

PO BOX 847824
DALLAS TX
75284-7824
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-2800
  • Fax: 469-800-2801
Mailing address:
  • Phone: 903-877-7777
  • Fax: 903-877-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10041302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: