Provider Demographics
NPI:1669459848
Name:ANG, PETER G (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:ANG
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 1:3231 WOODLAWN BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-7401
Mailing Address - Country:US
Mailing Address - Phone:903-465-1857
Mailing Address - Fax:903-327-8023
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3164
Practice Address - Country:US
Practice Address - Phone:903-463-5936
Practice Address - Fax:903-327-8023
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118773402Medicaid
TX1000045990AMedicaid
TX118773402Medicaid
TX86R455Medicare PIN