Basic Information
| Provider Information | |||||||||
| NPI: | 1942567961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DERMAN | ||||||||
| FirstName: | PETER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6020 W PARKER RD STE 200 | ||||||||
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| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938172 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5858 MAIN ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750334502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726085000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2012 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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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 | 207XS0117X | R7199 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
No ID Information.