Organization
NORTHWEST INFECTIOUS DISEASE AND TRAVEL MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PORNTHEP WATTANAMANO MD (PRESIDENT)
(713) 384-3229
Entity
Organization
Contact information
Practice address
5509 CORNISH ST, HOUSTON, TX 77007-4303
(832) 831-5089
(713) 360-7715
Mailing address
5509 CORNISH ST., HOUSTON, TX 77007-4303
(832) 831-5089
(713) 360-7715
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
L5950
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097LZ
BLUE CROSS BLUE SHIELDS
TX
05
—
171630001
—
TX
01
—
DC8420
MEDICARE RAILROAD
TX
Enumeration date
04/19/2006
Last updated
06/16/2021
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