Basic Information
| Provider Information | |||||||||
| NPI: | 1851339105 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GULCHIN ERGUN, MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4346 | ||||||||
| Address2: | DEPT 5400 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772104346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135265771 | ||||||||
| FaxNumber: | 7135262036 | ||||||||
| Practice Location | |||||||||
| Address1: | 6560 FANNIN STE 1160 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135265771 | ||||||||
| FaxNumber: | 7135262036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 09/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | ERGUN | ||||||||
| AuthorizedOfficialFirstName: | GULCHIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7135265771 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 172527701 | 05 | TX | MEDICAID |