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DR. WYLAN CORNELIUS PETERSON M.D. NPI 1659395523


NPI Information

NPI: 1659395523
Provider Name: DR. WYLAN CORNELIUS PETERSON, M.D.
Classification: Internal Medicine - 207RC0200X
Entity Type: Individual

Specialization: Critical Care Medicine

PECOS Registration: Yes

Address:
3551 ROGER BROOKE DR
ATT'N MS. SHAWANA JUDGE
FORT SAM HOUSTON, TX
ZIP 78234
Phone: (210) 916-1064
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DR. Wylan Cornelius Peterson, M.D. is a critical care medicine internal medicine in Fort Sam Houston, TX with 23 years of experience. The provider is an internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. DR. Wylan Cornelius Peterson, M.D. NPI is 1659395523. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF MISSOURI, KANSAS CITY, SCHOOL OF MEDICINE
Graduation Year:2001

The provider's business location address is:

3551 ROGER BROOKE DR
ATT'N MS. SHAWANA JUDGE
FORT SAM HOUSTON, TX
ZIP 78234-504
Phone: (210) 916-1064

The NPI 1659395523 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/26/2006 and was last updated on 3/8/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RC0200XInternal MedicineCritical Care MedicineQ0151TEXASYes
2208600000XSurgery35-08-5446OHIONo
3208600000XSurgeryQ0151TEXASNo
42086S0102XSurgerySurgical Critical CareQ0151TEXASNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.