Basic Information
| Provider Information | |||||||||
| NPI: | 1700876976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISHOE | ||||||||
| FirstName: | GARY | ||||||||
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| Credential: | L.V.N., O.P.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7401 S. MAIN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137992300 | ||||||||
| FaxNumber: | 7137943395 | ||||||||
| Practice Location | |||||||||
| Address1: | 10333 KUYKENDAHL | ||||||||
| Address2: | SUITE D | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813627700 | ||||||||
| FaxNumber: | 2813671323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 08/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0000928 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.