Basic Information
| Provider Information | |||||||||
| NPI: | 1386661908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | NICK | ||||||||
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| Credential: | M.D., FACEP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840186 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669165259 | ||||||||
| FaxNumber: | 2319224030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 WALLACE BLVD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062122000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | J7627 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 22034 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | G74618 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.