Basic Information
Provider Information
NPI: 1093280463
EntityType: 2
ReplacementNPI:  
OrganizationName: BAYLOR COLLEGE OF MEDICINE
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2 GREENWAY PLZ STE 900
Address2:  
City: HOUSTON
State: TX
PostalCode: 770460205
CountryCode: US
TelephoneNumber: 7137981750
FaxNumber: 7137984693
Practice Location
Address1: 6363 SAN FELIPE ST STE 150
Address2:  
City: HOUSTON
State: TX
PostalCode: 770572704
CountryCode: US
TelephoneNumber: 7137981000
FaxNumber: 7137984693
Other Information
ProviderEnumerationDate: 10/11/2018
LastUpdateDate: 10/11/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ALLISON
AuthorizedOfficialFirstName: RICHARD
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 7137981750
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XP3100X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
207XS0106X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
207XS0114X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
207XS0117X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
207XX0004X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
207XX0005X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
207XX0801X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
207X00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


Home