Provider Demographics
NPI:1992798987
Name:PEGANY, MOHINDER S (MD)
Entity type:Individual
Prefix:
First Name:MOHINDER
Middle Name:S
Last Name:PEGANY
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 1:6210 E HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:801 E WHITESTONE BLVD
Practice Address - Street 2:BLDG C
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5028
Practice Address - Country:US
Practice Address - Phone:512-259-3467
Practice Address - Fax:512-406-7303
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109020207R00000X
KS04-26572207R00000X
TXN3988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204972804Medicaid
0408163OtherUNITED HEALTHCARE
TX204972802Medicaid
TX204972801Medicaid
110148810OtherRAILROAD MEDICARE
TX204972803Medicaid
MO22148031OtherBLUE CROSS BLUE SHIELD
TXN3988OtherTEXAS MEDICAL LICENSE
110148810OtherRAILROAD MEDICARE
TX204972802Medicaid
TX263687YLP1Medicare PIN
TX204972804Medicaid
TXP00776712Medicare PIN
KS0009960AMedicare ID - Type Unspecified
MO0009960BMedicare ID - Type Unspecified
0408163OtherUNITED HEALTHCARE
TXP01170179Medicare PIN