MEDICARE: PETER EBERE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	008499	TX

General Provider Information

NPI Number	:	1184987448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER EBERE

Provider Business Mailing Address
First Line	:	3333 KNOLLCREST LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-2938
Country	:	US
Telephone Number	:	469-831-1960
Fax Number	:	972-222-6658

Provider Business Practice Location Address
First Line	:	3333 KNOLLCREST LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-2938
Country	:	US
Telephone Number	:	469-831-1960
Fax Number	:	972-222-6658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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Directions to “ PETER EBERE ” Practice Location

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