Individual
DR. THEODORE THOMAS PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2535 IRA E WOODS AVENUE, GRAPEVINE, TX 76051-3930
(817) 481-2121
(817) 488-4493
Mailing address
2535 IRA E WOODS AVENUE, GRAPEVINE, TX 76051-3930
(817) 481-2121
(817) 488-4493
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
F4371
TX
207XS0106X
Orthopaedic Hand Surgery Physician
F4371
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099325501
—
TX
01
—
82X722
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/21/2005
Last updated
04/27/2020
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