MEDICARE: FAME PEDIATRICS PA

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	208000000X	Pediatrics Physician		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508229394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAME PEDIATRICS PA

Provider Business Mailing Address
First Line	:	11003 RESOURCE PKWY
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77089-6141
Country	:	US
Telephone Number	:	713-955-7436
Fax Number	:	281-741-9475

Provider Business Practice Location Address
First Line	:	11003 RESOURCE PKWY
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77089-6141
Country	:	US
Telephone Number	:	713-955-7436
Fax Number	:	281-741-9475

Authorized Official
Title or Position	:	AUTHORIZED REP/OWNER
Name	:	MUHAMMAD FARRUKH NOOR
Credential	:	MD
Telephone Number	:	713-955-7436

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	10/21/2016

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Directions to “FAME PEDIATRICS PA ” Practice Location

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