Provider Demographics
NPI:1487729018
Name:PETER T. NGO, MD PA
Entity type:Organization
Organization Name:PETER T. NGO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-712-9171
Mailing Address - Street 1:PO BOX 3289
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78044-3289
Mailing Address - Country:US
Mailing Address - Phone:956-712-9171
Mailing Address - Fax:956-712-9402
Practice Address - Street 1:1710 E SAUNDERS ST
Practice Address - Street 2:SUITE B350
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5443
Practice Address - Country:US
Practice Address - Phone:956-712-9171
Practice Address - Fax:956-712-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1952174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0024PYOtherBLUE CROSS/BLUE SHIELD
TX161490101Medicaid
TXDA7630OtherPALMETTO
TXG90141Medicare UPIN
TX161490101Medicaid