Individual
PETER J ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
855 MONTGOMERY ST, DEPT OF OB/GYN, FORT WORTH, TX 76107-2553
(817) 735-2198
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
J0757
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115112804
—
TX
01
—
8U1330
BCBS
TX
01
—
P00695528
RAILROAD MEDICARE
TX
Enumeration date
07/31/2006
Last updated
11/08/2012
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