Healthcare Provider Details

I. General information

NPI: 1710066519
Provider Name (Legal Business Name): DEER PARK FAMILY CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 CENTER ST
DEER PARK TX
77536
US

IV. Provider business mailing address

2910 CENTER ST
DEER PARK TX
77536-4943
US

V. Phone/Fax

Practice location:
  • Phone: 281-479-5941
  • Fax: 281-542-1861
Mailing address:
  • Phone: 281-479-5941
  • Fax: 281-542-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY L STRAHAN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 281-479-5941