Provider Demographics
NPI:1366424368
Name:BURPEE, PEGGY A (DO)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:A
Last Name:BURPEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:A
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 22000
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-7200
Mailing Address - Country:US
Mailing Address - Phone:325-747-3408
Mailing Address - Fax:325-747-2525
Practice Address - Street 1:4235 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5635
Practice Address - Country:US
Practice Address - Phone:325-658-9151
Practice Address - Fax:325-481-2166
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB124756OtherWELLMED
I34022Medicare UPIN
TXTXB124756OtherWELLMED
I34022Medicare UPIN