Individual
LOC T VU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4000 SPENCER HWY, PASADENA, TX 77504-1202
(713) 359-2000
(713) 359-1004
Mailing address
PO BOX 200993, HOUSTON, TX 77216-0993
(281) 784-1111
(281) 784-1555
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
F4639
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140119227
—
TX
05
—
140119228
—
TX
01
—
1508836321
TRICARE SOUTH
TX
01
—
88287Z
BC/BS PROVIDER NUMBER
TX
Enumeration date
01/24/2006
Last updated
05/07/2010
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