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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6410 FANNIN ST, 600, HOUSTON, TX 77030-3000
(832) 325-7211
(713) 512-2245
Mailing address
7214 PRESTWICK ST, HOUSTON, TX 77025-1707
(713) 882-1407

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L2428
TX
207RC0000X
Cardiovascular Disease Physician
Primary
L2428
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
160581802
TX
01
8G3653
BCBS
TX
Enumeration date
07/10/2006
Last updated
07/21/2025
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