Provider Demographics
NPI:1083853568
Name:MORGAN, PETER BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:BENJAMIN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17406 NIGHTHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2882
Mailing Address - Country:US
Mailing Address - Phone:713-384-8614
Mailing Address - Fax:346-618-3421
Practice Address - Street 1:24510 NORTHWEST FWY STE 120
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2199
Practice Address - Country:US
Practice Address - Phone:346-618-3420
Practice Address - Fax:346-618-3421
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4317812085R0001X
TXM81962085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205724201Medicaid
TX182422901Medicaid
TX8FZ897OtherBLUE CROSS BLUE SHIELD
TX516436ZSVEMedicare PIN
TX516436ZSWDMedicare PIN
TX8FZ897OtherBLUE CROSS BLUE SHIELD
TX205724201Medicaid
TX8L15846Medicare PIN