Provider Demographics
NPI:1023353570
Name:DR. PETER CHANG
Entity type:Organization
Organization Name:DR. PETER CHANG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MDPHD
Authorized Official - Phone:713-479-1100
Mailing Address - Street 1:6565 W. LOOP S
Mailing Address - Street 2:#300
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-479-1100
Mailing Address - Fax:713-629-6032
Practice Address - Street 1:6565 W. LOOP S
Practice Address - Street 2:#300
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-479-1100
Practice Address - Fax:713-629-6032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. PETER CHANG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9292207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128025703Medicaid
TX000K19Medicare Oscar/Certification
TX128025703Medicaid