Individual
JANE DOAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6550 FANNIN ST STE 1501, HOUSTON, TX 77030
(713) 441-5177
Mailing address
6550 FANNIN ST STE 1501, HOUSTON, TX 77030-2743
(713) 441-5177
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12003
TX
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
05/22/2018
Last updated
10/05/2018
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