Provider Demographics
NPI:1730185190
Name:HARVEY, PETER MARSHALL (DPM)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MARSHALL
Last Name:HARVEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4307
Mailing Address - Country:US
Mailing Address - Phone:940-723-1054
Mailing Address - Fax:940-723-4646
Practice Address - Street 1:1612 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4307
Practice Address - Country:US
Practice Address - Phone:940-723-1054
Practice Address - Fax:940-723-4646
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0346OtherSTATE LICENSE NUMBER
TX000826001Medicaid
TX00F621OtherBLUE CROSS BLUE SHIELD
TX482039423OtherMEDICAID DMERC NUMBER
TX000826001Medicaid
TX75-1281136OtherTAX ID NUMBER
1114410001Medicare NSC
TX482039423OtherMEDICAID DMERC NUMBER