Provider Demographics
NPI:1093404303
Name:FARAG, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:FARAG
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 1:3508 S LAMAR BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8179
Mailing Address - Country:US
Mailing Address - Phone:512-989-5959
Mailing Address - Fax:
Practice Address - Street 1:3508 S LAMAR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8179
Practice Address - Country:US
Practice Address - Phone:512-989-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2025-06-25
Deactivation Date:2023-05-31
Deactivation Code:
Reactivation Date:2025-06-25
Provider Licenses
StateLicense IDTaxonomies
TXU1002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine