Organization
SPACE CENTER PRIMARY CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERAN Y WONG MD (PHYSICIAN)
(281) 286-6000
Entity
Organization
Contact information
Practice address
907 BAY AREA BLVD STE B, HOUSTON, TX 77058-2665
(281) 286-6000
(281) 488-8686
Mailing address
907 BAY AREA BLVD STE B, HOUSTON, TX 77058-2665
(281) 286-6000
(281) 488-8686
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
Q4875
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
454495ZRZ
MEDICARE ID
TX
Enumeration date
10/28/2016
Last updated
11/28/2016
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