Provider Demographics
NPI:1265482475
Name:LANASA, PETER SR (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:LANASA
Suffix:SR
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 1:801 W INTERSTATE 20
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5851
Mailing Address - Country:US
Mailing Address - Phone:817-417-1132
Mailing Address - Fax:817-804-8166
Practice Address - Street 1:801 W INTERSTATE 20
Practice Address - Street 2:SUITE 1
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5851
Practice Address - Country:US
Practice Address - Phone:817-417-1132
Practice Address - Fax:817-804-8166
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL87882085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165025106Medicaid
TX165025105Medicaid
TX1650251-02Medicaid
TX165025106OtherMEDICAID OTHER
TX1650251-01Medicaid
TX165025107Medicaid
TX1650251-01Medicaid
TX165025107Medicaid
TXF07029Medicare UPIN