Provider Demographics
NPI:1356421770
Name:PEDEN, ERIC (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:PEDEN
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 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-5200
Mailing Address - Fax:713-793-7428
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-5200
Practice Address - Fax:713-793-7428
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8709208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038786206Medicaid
TXP01039339OtherRR MEDICARE
TX038786201Medicaid
TX8W8519OtherBLUE CROSS BLUE SHIELD
TXP00434000OtherRR MEDICARE
TX038786207Medicaid
G28489Medicare UPIN
TX8J7866Medicare PIN
TXTXB145705Medicare PIN
TX038786207Medicaid
TX8L10063Medicare PIN