MEDICARE: DR. PATRICK H PETERS JR. 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	207R00000X	Internal Medicine Physician	E9334	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82210F	OTHER	TX	BLUE CROSS BLUE SHIELD
2	78238A001	OTHER	TX	TRICARE

General Provider Information

NPI Number	:	1578505731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK H PETERS JR. M.D.

Provider Business Mailing Address
First Line	:	6547 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1434
Country	:	US
Telephone Number	:	210-521-7676
Fax Number	:	210-681-0949

Provider Business Practice Location Address
First Line	:	6547 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1434
Country	:	US
Telephone Number	:	210-521-7676
Fax Number	:	210-681-0949

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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