Provider Demographics
NPI:1174567663
Name:PETERS, DOUGLAS KNOX (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KNOX
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6360 W SAM HOUSTON PKWY N
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041
Mailing Address - Country:US
Mailing Address - Phone:713-280-0400
Mailing Address - Fax:713-453-6251
Practice Address - Street 1:6360 W SAM HOUSTON PKWY N
Practice Address - Street 2:STE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041
Practice Address - Country:US
Practice Address - Phone:713-280-0400
Practice Address - Fax:713-896-0702
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046233502Medicaid
8A2292Medicare ID - Type Unspecified
TXG29743Medicare UPIN
G29743Medicare UPIN