Basic Information
| Provider Information | |||||||||
| NPI: | 1295919223 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CYPRESS PHYSICIANS ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13215 DOTSON RD. | ||||||||
| Address2: | 160 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770704535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815370300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13215 DOTSON RD | ||||||||
| Address2: | 160 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815370300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2815370300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CK3588 | 01 | TX | MEDICARE RAILROAD PIN | OTHER | 0066HQ | 01 | TX | BCBS PIN | OTHER |