Provider Demographics
NPI:1720088206
Name:NUTSON, PETER ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:NUTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W PECAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3069
Mailing Address - Country:US
Mailing Address - Phone:512-421-3750
Mailing Address - Fax:512-421-3751
Practice Address - Street 1:2700 W PECAN ST STE 102
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3069
Practice Address - Country:US
Practice Address - Phone:512-421-3750
Practice Address - Fax:512-421-3751
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144018202Medicaid
TXP00447140OtherRAILROAD MEDICARE
TXTXB125933OtherWELLMED PTAN
TX144018202Medicaid
TX8F6663Medicare PIN
TXP00447140OtherRAILROAD MEDICARE