MEDICARE: F CHARLES PETR MD PA

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	207N00000X	Dermatology Physician	H2684	TX

General Provider Information

NPI Number	:	1720209406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	F CHARLES PETR MD PA

Provider Business Mailing Address
First Line	:	2391 NE LOOP 410
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5600
Country	:	US
Telephone Number	:	210-656-3376
Fax Number	:	210-656-4864

Provider Business Practice Location Address
First Line	:	2391 NE LOOP 410
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5600
Country	:	US
Telephone Number	:	210-656-3376
Fax Number	:	210-656-4864

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. SANDRA DAWN SMITH
Credential	:
Telephone Number	:	210-656-3376

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	10/30/2007

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