Provider Demographics
NPI:1124214564
Name:NAUS, PETER JON (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JON
Last Name:NAUS
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 1:1001 WALDROP
Mailing Address - Street 2:702
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4704
Mailing Address - Country:US
Mailing Address - Phone:817-461-6871
Mailing Address - Fax:817-860-6441
Practice Address - Street 1:1001 WALDROP
Practice Address - Street 2:702
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4704
Practice Address - Country:US
Practice Address - Phone:817-461-6871
Practice Address - Fax:817-860-6441
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2305207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00AH49OtherBCBS
0821912OtherAETNA
TX0031861001Medicaid
TX0031861001Medicaid
TXC19793Medicare UPIN