MEDICARE: SANDRA PEYTON MD

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	207Q00000X	Family Medicine Physician	K3392	TX

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
2	K3392	OTHER	TX	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952401358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA PEYTON MD

Provider Business Mailing Address
First Line	:	546 E SANDY LAKE RD STE 210
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-5786
Country	:	US
Telephone Number	:	469-671-3337
Fax Number	:	469-671-3338

Provider Business Practice Location Address
First Line	:	546 E SANDY LAKE RD STE 210
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-5786
Country	:	US
Telephone Number	:	469-671-3337
Fax Number	:	469-671-3338

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	09/29/2010

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Directions to “ SANDRA PEYTON MD” Practice Location

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