Healthcare Provider Details

I. General information

NPI: 1487622742
Provider Name (Legal Business Name): PAUL N HOUSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 E NATIONAL AVE
BRAZIL IN
47834-2718
US

IV. Provider business mailing address

1216 E NATIONAL AVE
BRAZIL IN
47834-2718
US

V. Phone/Fax

Practice location:
  • Phone: 812-448-3551
  • Fax: 812-443-7303
Mailing address:
  • Phone: 812-448-3551
  • Fax: 812-443-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01030315A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: