Individual
DR. PETER ANDREW MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
3409 WORTH ST STE 500, DALLAS, TX 75246-2057
(214) 841-2000
(214) 841-2015
Mailing address
16980 DALLAS PKWY STE 200, DALLAS, TX 75248-1974
(972) 391-1915
(972) 391-2061
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
4301058147
MI
207RC0000X
Cardiovascular Disease Physician
Primary
P9222
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060F360210
BCBSM
MI
01
—
1M7388
MEDICARE PIN
TX
05
—
3379307-01
—
TX
05
—
3379307-02
—
TX
05
—
4450728
—
MI
Enumeration date
03/28/2006
Last updated
03/17/2021
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