MEDICARE: DR. PETER JOHN RAPPA 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	208100000X	Physical Medicine & Rehabilitation Physician	H8345	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	250013233	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629087127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER JOHN RAPPA M.D.

Provider Business Mailing Address
First Line	:	14902 PRESTON RD
Second Line	:	SUITE 404-804
City	:	DALLAS
State	:	TX
Zip	:	75254-9191
Country	:	US
Telephone Number	:	972-428-1694
Fax Number	:	972-428-1619

Provider Business Practice Location Address
First Line	:	2301 MARSH LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8497
Country	:	US
Telephone Number	:	942-428-1694
Fax Number	:	972-428-1619

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/18/2009

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