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Organization
THIRD COAST EMERGENCY PHYSICIANS SID PETERSON PA
Active
Organization
THIRD COAST EMERGENCY PHYSICIANS SID PETERSON PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM ROBERTS MD (PRESIDENT)
(512) 452-8533
Entity
Organization
Contact information
Practice address
551 HILL COUNTRY DR, KERRVILLE, TX 78028-6085
(830) 896-4200
Mailing address
6300 LA CALMA DR, SUITE 200, AUSTIN, TX 78752-3843
(512) 452-8533
(512) 452-9306
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012NJ
BCBS
TX
01
—
0070BD
BCBS
TX
05
—
081037603
—
TX
01
—
081037604
CSHCN
TX
Enumeration date
06/04/2006
Last updated
04/27/2010
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