WALTER RUSSELL PETERS M.D. M.B.A NPI 1316941123

NPI Information

NPI: 1316941123
Provider Name: WALTER RUSSELL PETERS, M.D., M.B.A
Classification: Colon & Rectal Surgery - 208C00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
3409 WORTH ST
WORTH TOWER, SUITE 640
DALLAS, TX
ZIP 75246
Phone: (469) 800-7180
Get Directions

Walter Russell Peters, M.D., M.B.A is a colon rectal surgery in Dallas, TX. The provider is a colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. Walter Russell Peters, M.D., M.B.A NPI is 1316941123. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3409 WORTH ST
WORTH TOWER, SUITE 640
DALLAS, TX
ZIP 75246-029
Phone: (469) 800-7180
Fax: (469) 800-7190

The NPI 1316941123 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 6/9/2005 and was last updated on 4/7/2022.

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	License Number	License State	Primary
1	208600000X	Surgery	R6G45	MISSOURI	No
2	208C00000X	Colon & Rectal Surgery	R6G45	MISSOURI	No
3	208C00000X	Colon & Rectal Surgery	Q6358	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	25055	OTHER	MISSOURI	ANTHEM BLUECROSS BLUESHIE
2	5125	OTHER	MISSOURI	HEALTHCARE USA
3	4343317	OTHER	TEXAS	AETNA
4	A10787	OTHER	MISSOURI	MERCY
5	3548646-01	MEDICAID	TEXAS
6	123497	OTHER	MISSOURI	PHCS
7	28058	OTHER	MISSOURI	GHP
8	8FM794	OTHER	TEXAS	BCBS
9	202523015	MEDICAID	MISSOURI
10	1284609	OTHER	MISSOURI	UNITED HEALTHCARE
11	1316941123	OTHER	TEXAS	NPI
12	4343317	OTHER	MISSOURI	AETNA
13	431428562	OTHER	MISSOURI	GREAT WEST

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: 4/28/2024

NPI Synchronization or Removal

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