Individual
FANGYU PENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5323 HARRY HINES BLVD, NE3.240, DALLAS, TX 75390-8542
(214) 645-2625
Mailing address
5323 HARRY HINES BLVD, NE3.240, DALLAS, TX 75390-8542
(214) 645-2625
(214) 645-6479
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
N1833
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M76490221
MIDICARE PROVIDER NUMBER
TX
Enumeration date
06/01/2006
Last updated
02/01/2021
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