Provider Demographics
NPI:1386604700
Name:MCCULLOUGH, PETER ANDREW (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:MCCULLOUGH
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:16980 DALLAS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1974
Mailing Address - Country:US
Mailing Address - Phone:972-391-1915
Mailing Address - Fax:972-391-2061
Practice Address - Street 1:3409 WORTH ST STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2057
Practice Address - Country:US
Practice Address - Phone:214-841-2000
Practice Address - Fax:214-841-2015
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058147207RC0000X
TXP9222207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3379307-01Medicaid
MI4450728Medicaid
TX1M7388OtherMEDICARE PIN
TX3379307-02Medicaid
MI060F360210OtherBCBSM
TX3379307-02Medicaid
TX351397YKTPMedicare PIN
TX351397YKY6Medicare PIN