Healthcare Provider Details

I. General information

NPI: 1124280599
Provider Name (Legal Business Name): LUNG AND ASTHMA CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 E HIGHWAY 35
ANGLETON TX
77515-3835
US

IV. Provider business mailing address

6550 FANNIN ST STE 2421
HOUSTON TX
77030-2748
US

V. Phone/Fax

Practice location:
  • Phone: 979-864-3329
  • Fax:
Mailing address:
  • Phone: 713-795-5155
  • Fax: 713-795-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberJ9248
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberJ9248
License Number StateTX

VIII. Authorized Official

Name: DR. GHASSAN A NOUREDDINE
Title or Position: OWNER
Credential: M.D.
Phone: 713-795-5155