Individual
PETER PITONAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
703 E FLEISHEL AVE, STE 4000, TYLER, TX 75701-2015
(903) 606-7000
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
00024770
AL
207RC0000X
Cardiovascular Disease Physician
Primary
M9934
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051511035
—
AL
01
—
110248812
RAILROAD MEDICARE
AL
01
—
51511035
BLUE CROSS BLUE SHIELD
AL
01
—
75-2616977-132
TRICARE
TX
Enumeration date
10/13/2006
Last updated
04/18/2023
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