1992897060 NPI number — PETER MENSER DEYOUNG M.D.

Table of content: PETER MENSER DEYOUNG M.D. (NPI 1992897060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992897060 NPI number — PETER MENSER DEYOUNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEYOUNG
Provider First Name:
PETER
Provider Middle Name:
MENSER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992897060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5430 FREDERICKSBURG RD STE 508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-541-8281
Provider Business Mailing Address Fax Number:
210-541-9123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 S PARK ST
Provider Second Line Business Practice Location Address:
DIVISION OF NEONATOLOGY-6 CENTER
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53715-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-252-6561
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , with the licence number:  46563-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: M5688 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)