Provider Demographics
NPI:1528530326
Name:DZIEWULSKI, PETER GEORGE (MBBS FRCS(PLAST))
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:GEORGE
Last Name:DZIEWULSKI
Suffix:
Gender:M
Credentials:MBBS FRCS(PLAST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 650859
Mailing Address - Street 2:DEPT 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0859
Mailing Address - Country:GB
Mailing Address - Phone:409-772-6784
Mailing Address - Fax:
Practice Address - Street 1:UTMB 301 UNIVERSITY BOULEVARD 6.146 JOHN SEALY ANNEX
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0001
Practice Address - Country:US
Practice Address - Phone:409-772-0504
Practice Address - Fax:409-772-5611
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX46373208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery