Individual
DR. JOHN MATHEW POOTHULLIL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.,F.R.C.P,F.A.A.P
Contact information
Practice address
201 OAK DR S, SUITE 106, LAKE JACKSON, TX 77566-5676
(979) 297-8006
(979) 297-5919
Mailing address
201 OAK DR S, SUITE 106, LAKE JACKSON, TX 77566-5676
(979) 297-8006
(979) 297-5919
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
E6880
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02914600-01
CIGNA
TX
01
—
02914600-13
CIGNA HMO
TX
01
—
02914600-14
CIGNA SELECT
TX
01
—
10020011
AMERIKIDS
TX
01
—
2225592
BCBS BLUE LINK
TX
Enumeration date
11/21/2005
Last updated
07/08/2007
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