Provider Demographics
NPI:1083853568
Name:MORGAN, PETER BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BENJAMIN
Last Name:MORGAN
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 1:18400 KATY FWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1286
Mailing Address - Country:US
Mailing Address - Phone:832-522-2873
Mailing Address - Fax:832-522-8117
Practice Address - Street 1:17183 INTERSTATE 45 SOUTH
Practice Address - Street 2:MEDICAL OFFICE BLDG 1, SUITE 110
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77385-3312
Practice Address - Country:US
Practice Address - Phone:936-270-3413
Practice Address - Fax:936-270-3414
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8196174400000X, 2085R0001X
PAMD4317812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FZ897OtherBLUE CROSS BLUE SHIELD
TX182422901Medicaid
TX205724201Medicaid
TX516436ZSVEMedicare PIN
TX516436ZSWDMedicare PIN
TX8FZ897OtherBLUE CROSS BLUE SHIELD
TX205724201Medicaid
TX8L15846Medicare PIN