Healthcare Provider Details

I. General information

NPI: 1265516306
Provider Name (Legal Business Name): CENTER FOR FAMILY & PREVENTIVE MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 FM 2100 RD STE A
CROSBY TX
77532-9161
US

IV. Provider business mailing address

14700 FM 2100 RD STE A
CROSBY TX
77532-9161
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-2568
  • Fax: 281-328-2039
Mailing address:
  • Phone: 281-328-2568
  • Fax: 281-328-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE1466, AND K9887
License Number StateTX

VIII. Authorized Official

Name: DR. JUDSON S HENDERSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 281-328-2568