Individual
DI SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9774 KATY FWY STE 500, HOUSTON, TX 77055-6240
(832) 358-0200
Mailing address
2222 MARONEAL ST UNIT 444, HOUSTON, TX 77030-3258
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
233715
NY
207P00000X
Emergency Medicine Physician
Primary
M2134
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8W7219
BCBS
TX
Enumeration date
07/17/2006
Last updated
09/15/2023
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