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General NPI Number Information
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NPI Number | 1710688247
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Entity Type | Organization
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Legal Business Name | CIBOLO CREEK ALLERGY PA
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 109 YOALANA, SUITE 110
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City | BOERNE
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State | TX
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Zip | 78006
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Country | US
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Telephone | 830-997-5559
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Fax |
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Provider Business Mailing Address
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Address Line | 110 E LIVE OAK ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4450
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Country | US
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Telephone | 830-997-5559
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Fax | 830-997-5558
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Authorized Official
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Title or Position | MD/OWNER
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Name | JASON PEET
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Credential | MD
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Telephone | 830-997-5559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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