Provider Demographics
NPI:1902925795
Name:PERALTA, VICTOR H (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:H
Last Name:PERALTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:222 W. LAS COLINAS BLVD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-236-0096
Practice Address - Street 1:941 E PARK ROW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-4508
Practice Address - Country:US
Practice Address - Phone:817-522-0221
Practice Address - Fax:817-522-0401
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF0114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB124112Medicare PIN
TX1352775-08Medicaid