Organization
ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA
Active
Other names
Eagle's Trace Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY NORMAN M.D. (PRESIDENT)
(410) 402-2257
Entity
Organization
Contact information
Practice address
14703 EAGLE VISTA DR, HOUSTON, TX 77077-5275
(281) 249-7100
(281) 249-7365
Mailing address
5730 EXECUTIVE DR STE 230, CATONSVILLE, MD 21228-1762
(281) 249-7100
(281) 249-7365
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
213E00000X
Podiatrist
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
364SG0600X
Gerontology Clinical Nurse Specialist
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0089EP
BCBS - FEATHERSTON
—
01
—
0093NP
BCBS OF TX
—
01
—
8AS969
BCBS - FEATHERSTON
—
Enumeration date
07/21/2006
Last updated
12/08/2022
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