Basic Information
| Provider Information | |||||||||
| NPI: | 1992798987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEGANY | ||||||||
| FirstName: | MOHINDER | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6210 E HIGHWAY 290 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787231142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124839596 | ||||||||
| FaxNumber: | 5124066216 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 E WHITESTONE BLVD | ||||||||
| Address2: | BLDG C | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786135028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122593467 | ||||||||
| FaxNumber: | 5124067303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 109020 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 04-26572 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N3988 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 204972804 | 05 | TX | MEDICAID | 0408163 | 01 | UNITED HEALTHCARE | OTHER | 204972802 | 05 | TX | MEDICAID | 204972801 | 05 | TX | MEDICAID | 110148810 | 01 | RAILROAD MEDICARE | OTHER | 204972803 | 05 | TX | MEDICAID | 22148031 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | N3988 | 01 | TX | TEXAS MEDICAL LICENSE | OTHER |