Provider Demographics
NPI:1306122478
Name:PETERS AND TODAR, PLLC
Entity type:Organization
Organization Name:PETERS AND TODAR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-694-0858
Mailing Address - Street 1:126 GIANT CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2253
Mailing Address - Country:US
Mailing Address - Phone:254-694-0858
Mailing Address - Fax:270-573-7794
Practice Address - Street 1:203 E JEFFERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2302
Practice Address - Country:US
Practice Address - Phone:254-694-9457
Practice Address - Fax:270-573-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10635251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280488201Medicaid