Organization
PAN-AMERICAN OB-GYN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENO LOUREIRO MIGUEL MD (PHYSICIAN OWNER)
(713) 694-6600
Entity
Organization
Contact information
Practice address
6031 AIRLINE DR, HOUSTON, TX 77076-4209
(713) 694-6600
(713) 694-6616
Mailing address
6031 AIRLINE DR, HOUSTON, TX 77076-4209
(713) 694-6600
(713) 694-6616
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
L5466
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0026JV
BCBS
—
01
—
10004951
AMERIGROUP
TX
Enumeration date
04/23/2007
Last updated
09/09/2021
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