Healthcare Provider Details

I. General information

NPI: 1750396628
Provider Name (Legal Business Name): PETER L DY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 S CAGE BLVD STE B
PHARR TX
78577-5961
US

IV. Provider business mailing address

PO BOX 2946
MCALLEN TX
78502-2946
US

V. Phone/Fax

Practice location:
  • Phone: 956-283-8990
  • Fax: 956-283-8980
Mailing address:
  • Phone: 956-283-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK9055
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIENNA DY
Title or Position: MANAGER
Credential:
Phone: 956-283-8990