Provider Demographics
NPI:1285623009
Name:CHANG, PETER (MD, PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 272629
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2629
Mailing Address - Country:US
Mailing Address - Phone:713-479-1100
Mailing Address - Fax:713-629-6032
Practice Address - Street 1:6565 WEST LOOP STH
Practice Address - Street 2:STE 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9292207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128025703Medicaid
TX00DK19Medicare ID - Type Unspecified
TXC14374Medicare UPIN
TX128025703Medicaid