Active NPI
George Alexander Peterkin III, MD
- Surgery Physician
- Houston, TX
National Provider Identifier
1457469421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- G9379
- Practice address
- 2500 Fondren
Houston, TX 77063 - Phone
- (713) 917-5741
- Fax
- (713) 917-5795
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | G9379 | TX | Primary |
Addresses
Primary practice location
2500 Fondren
Houston, TX 77063
Mailing address
2500 Fondren
Houston, TX 77063
Phone (713) 917-5741
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 038468701 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G9379 | TX | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457469421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 FONDREN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77063",
"telephone_number": "713-917-5741",
"fax_number": "713-917-5795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 FONDREN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77063",
"telephone_number": "713-917-5741",
"fax_number": "713-917-5795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERKIN III",
"first_name": "GEORGE",
"middle_name": "ALEXANDER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "TX",
"license": "G9379",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "038468701",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.