Provider Demographics
NPI:1053331900
Name:CHEN, PENG ROC (MD)
Entity Type:Individual
Prefix:
First Name:PENG
Middle Name:ROC
Last Name:CHEN
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 1:6400 FANNIN ST STE 2070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1541
Mailing Address - Country:US
Mailing Address - Phone:713-486-7747
Mailing Address - Fax:
Practice Address - Street 1:6400 FANNIN ST STE 2800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1534
Practice Address - Country:US
Practice Address - Phone:713-486-8000
Practice Address - Fax:713-486-8088
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426665207T00000X
TXM6564207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183156202Medicaid
TXP00639900OtherMEDICARE RR
TX8AR784OtherBCBSTX
TX183156204Medicaid
TX8AA321OtherBCBS
TX183156201Medicaid
TX183156203Medicaid
TX183156202Medicaid
TX183156201Medicaid
TX183156203Medicaid
TX8K8070Medicare PIN
TX8K0882Medicare PIN
8G7653Medicare PIN