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Organization

EGRET BAY NEUROLOGY, PA

Active
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Organization

EGRET BAY NEUROLOGY, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MAVIS D FUJII MD (PRESIDENT)
(281) 333-9933
Entity
Organization

Contact information

Practice address
18333 EGRET BAY BLVD, SUITE 650, HOUSTON, TX 77058-3860
(281) 333-9933
(281) 333-4072
Mailing address
18333 EGRET BAY BLVD, SUITE 650, HOUSTON, TX 77058-3860
(281) 333-9933
(281) 333-4072

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
554544
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018MQ
BLUE CROSS
TX
Enumeration date
11/30/2007
Last updated
12/05/2007
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