MEDICARE: DR. ERIC SABONGHY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	L0558	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AA920	OTHER	TX	BLUE CROSS AND BLUE SHIELD OF TEXAS
2	7857805	OTHER	TX	AETNA
3	613174800	OTHER	TX	DEPARTMENT OF LABOR

General Provider Information

NPI Number	:	1023093291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC SABONGHY M.D.

Provider Business Mailing Address
First Line	:	6400 FANNIN ST STE 1700
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1526
Country	:	US
Telephone Number	:	713-486-1700
Fax Number	:	713-467-6682

Provider Business Practice Location Address
First Line	:	10125 KATY FWY STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1287
Country	:	US
Telephone Number	:	713-486-1700
Fax Number	:	713-467-6682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2005
Last Update Date	:	10/11/2018

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