MEDICARE: JUDITH TOMBOBI PEYECHU M.D.

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	P9935	TX
2	207Q00000X	Family Medicine Physician	P9935	TX

General Provider Information

NPI Number	:	1275720427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH TOMBOBI PEYECHU M.D.

Provider Business Mailing Address
First Line	:	8340 GREENLEAF RIDGE WAY
Second Line	:	APT C2
City	:	CONROE
State	:	TX
Zip	:	77385-1119
Country	:	US
Telephone Number	:	240-463-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 GRANBERRY ST
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4547
Country	:	US
Telephone Number	:	832-644-6496
Fax Number	:	832-644-6499

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

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/11/2022

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