Provider Demographics
NPI:1457536989
Name:PETER A. KANGOS, MD, PA
Entity Type:Organization
Organization Name:PETER A. KANGOS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:KANGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-250-1997
Mailing Address - Street 1:12411 HYMEADOW DR
Mailing Address - Street 2:SUITE 3F
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1874
Mailing Address - Country:US
Mailing Address - Phone:512-250-1997
Mailing Address - Fax:512-250-1529
Practice Address - Street 1:12411 HYMEADOW DR
Practice Address - Street 2:SUITE 3F
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1874
Practice Address - Country:US
Practice Address - Phone:512-250-1997
Practice Address - Fax:512-250-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty