Basic Information
| Provider Information | |||||||||
| NPI: | 1528070182 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOMBALL UROLOGY ASSOCIATES,PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 919 GRAHAM DR | ||||||||
| Address2: | STE. A | ||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773756408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812909800 | ||||||||
| FaxNumber: | 2812909824 | ||||||||
| Practice Location | |||||||||
| Address1: | 919 GRAHAM DR | ||||||||
| Address2: | STE. A | ||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773756408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812909800 | ||||||||
| FaxNumber: | 2812909824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FLECK | ||||||||
| AuthorizedOfficialFirstName: | LOIS | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAAGER | ||||||||
| AuthorizedOfficialTelephone: | 2812909800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.