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Organization
JACINTO MEDICAL GROUP P A
Active
Organization
JACINTO MEDICAL GROUP P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAGGIE KHAN (CREDENTIALING COORDINATOR)
(281) 425-3844
Entity
Organization
Contact information
Practice address
2800 GARTH RD, BAYTOWN, TX 77521-3947
(281) 425-3800
(281) 425-3992
Mailing address
2800 GARTH RD, BAYTOWN, TX 77521-3947
(281) 425-3800
(281) 425-3992
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
816738-03
TX
207R00000X
Internal Medicine Physician
816738-03
TX
207RG0100X
Gastroenterology Physician
816738-03
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U80B
BCBS
TX
05
—
085781501
—
TX
Enumeration date
06/12/2006
Last updated
02/13/2012
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