MEDICARE: PETER D SCHOLL D.D.S.,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	207Y00000X	Otolaryngology Physician	G0078	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4260748	OTHER	TX	AETNA
2	G0078	OTHER	TX	STATE LICENSE
3	83C682	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1720059504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER D SCHOLL D.D.S.,M.D.

Provider Business Mailing Address
First Line	:	7200 WYOMING SPRINGS DR STE 1400
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4306
Country	:	US
Telephone Number	:	512-458-6391
Fax Number	:	512-580-0097

Provider Business Practice Location Address
First Line	:	7200 WYOMING SPRINGS DR STE 1400
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4306
Country	:	US
Telephone Number	:	512-458-6391
Fax Number	:	512-580-0097

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	11/24/2020

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Directions to “ PETER D SCHOLL D.D.S.,M.D.” Practice Location

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