MEDICARE: STEPHANIE BAUSSAN 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	2085R0202X	Diagnostic Radiology Physician	R7660	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1477849818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BAUSSAN M.D.

Provider Business Mailing Address
First Line	:	6550 FANNIN ST STE 749
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2738
Country	:	US
Telephone Number	:	713-441-7465
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 749
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2738
Country	:	US
Telephone Number	:	713-441-7465
Fax Number	:

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

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	08/05/2020

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