Individual
TU T MAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6410 FANNIN ST STE 500, HOUSTON, TX 77030-3005
(713) 500-5663
Mailing address
6410 FANNIN ST STE 500, HOUSTON, TX 77030-3005
(832) 325-6516
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
BP10047236
TX
2080P0206X
Pediatric Gastroenterology Physician
Primary
Q7918
TX
Other
Enumeration date
04/13/2013
Last updated
12/03/2020
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