Healthcare Provider Details

I. General information

NPI: 1023353570
Provider Name (Legal Business Name): DR. PETER CHANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 W. LOOP S #300
BELLAIRE TX
77401
US

IV. Provider business mailing address

6565 W. LOOP S #300
BELLAIRE TX
77401
US

V. Phone/Fax

Practice location:
  • Phone: 713-479-1100
  • Fax: 713-629-6032
Mailing address:
  • Phone: 713-479-1100
  • Fax: 713-629-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberF9292
License Number StateTX

VIII. Authorized Official

Name: DR. PETER CHANG
Title or Position: OWNER
Credential: MDPHD
Phone: 713-479-1100