MEDICARE: DR. PETER R DEFRANK DPM

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	213E00000X	Podiatrist	0866	TX
2	213ES0131X	Foot Surgery Podiatrist	0866	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01242887	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	75-2018765	OTHER	TX	TAX ID
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629044144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER R DEFRANK DPM

Provider Business Mailing Address
First Line	:	7709 ALTO CARO DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-4303
Country	:	US
Telephone Number	:	214-866-5313
Fax Number	:	972-947-3976

Provider Business Practice Location Address
First Line	:	7709 ALTO CARO DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-4303
Country	:	US
Telephone Number	:	214-866-5313
Fax Number	:	972-947-3976

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	03/03/2015

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Directions to “ DR. PETER R DEFRANK DPM” Practice Location

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