Provider Demographics
NPI:1760451389
Name:PETR, F CHARLES JR (MD)
Entity type:Individual
Prefix:
First Name:F
Middle Name:CHARLES
Last Name:PETR
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:401 AUSTIN HWY
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4640
Mailing Address - Country:US
Mailing Address - Phone:210-656-3376
Mailing Address - Fax:210-656-4864
Practice Address - Street 1:401 AUSTIN HWY
Practice Address - Street 2:STE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4640
Practice Address - Country:US
Practice Address - Phone:210-656-3376
Practice Address - Fax:210-656-4864
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2017-08-08
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Provider Licenses
StateLicense IDTaxonomies
TXH2684207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E41382Medicare UPIN