Individual
QIONG GAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
P O BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
Primary
R6398
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
393934001
—
TX
01
—
393934002
CSHCN (MEDICAID)
TX
01
—
8KB008
BCBS
TX
Enumeration date
03/28/2012
Last updated
08/22/2019
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