Provider Demographics
NPI:1215124805
Name:KAN, PETER T (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:KAN
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0517
Mailing Address - Country:US
Mailing Address - Phone:409-772-0330
Mailing Address - Fax:409-772-1742
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-3603
Practice Address - Country:US
Practice Address - Phone:409-772-0330
Practice Address - Fax:409-772-1742
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111547207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14JP0OtherBLUE CROSS BLUE SHIELD
FL004674800Medicaid
FLFW789ZMedicare PIN