Individual
MISS GAIL TYRIA HOUSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
210 GRANT AVE, ROOM 1809, FORT LEAVENWORTH, KS 66027-1231
(913) 758-3791
Mailing address
2412 MOUNTAIN RD, JOPPA, MD 21085-2338
(410) 262-4305
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C100031
MD
Other
Enumeration date
11/18/2005
Last updated
07/08/2007
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