Basic Information
| Provider Information | |||||||||
| NPI: | 1114303427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXANS MULTISPECIALTY MEDICAL GROUP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9525 KATY FWY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138637246 | ||||||||
| FaxNumber: | 8883712259 | ||||||||
| Practice Location | |||||||||
| Address1: | 9525 KATY FWY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138637246 | ||||||||
| FaxNumber: | 8883712259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2015 | ||||||||
| LastUpdateDate: | 08/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | AVES | ||||||||
| AuthorizedOfficialFirstName: | TEODULO | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9363218627 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 207LP2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.