Healthcare Provider Details

I. General information

NPI: 1285623009
Provider Name (Legal Business Name): PETER CHANG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 WEST LOOP STH STE 300
BELLAIRE TX
77401
US

IV. Provider business mailing address

P.O. BOX 272629
HOUSTON TX
77077-2629
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:
Title or Position:
Credential:
Phone: