Individual
PHI HO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
12711 WINDING MANOR DR, HOUSTON, TX 77044-6027
(832) 623-3125
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
T0515
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Enumeration date
04/21/2016
Last updated
02/24/2025
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