Provider Demographics
NPI:1982716783
Name:CHERN, PEGGY LEE ANN (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:LEE ANN
Last Name:CHERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 BEE CAVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4719
Mailing Address - Country:US
Mailing Address - Phone:512-328-3376
Mailing Address - Fax:512-666-3767
Practice Address - Street 1:8825 BEE CAVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4719
Practice Address - Country:US
Practice Address - Phone:512-328-3376
Practice Address - Fax:512-540-5243
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2984207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CA497OtherBCBSTX INDIVIDUAL #
TX211726901Medicaid
TX211726901Medicaid
TX8CA497OtherBCBSTX INDIVIDUAL #