=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457415754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER J YEH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 07/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4888 LOOP CENTRAL DR STE 540
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77081-2227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-661-8900
-----------------------------------------------------
Fax | 713-661-5535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20406
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77225-0406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-661-8900
-----------------------------------------------------
Fax | 713-661-5535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | K5751
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------