MEDICARE: EAST HOUSTON MEDICAL GROUP

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1710924568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST HOUSTON MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1910 JOHN RALSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77013-5518
Country	:	US
Telephone Number	:	713-673-9000
Fax Number	:	713-674-2493

Provider Business Practice Location Address
First Line	:	1910 JOHN RALSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77013-5518
Country	:	US
Telephone Number	:	713-673-9000
Fax Number	:	713-674-2493

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. LORIE F CRAM
Credential	:	M.D.
Telephone Number	:	713-673-9000

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/23/2008

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Directions to “EAST HOUSTON MEDICAL GROUP ” Practice Location

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