Healthcare Provider Details

I. General information

NPI: 1659372969
Provider Name (Legal Business Name): BAYSHORE FAMILY PRACTICE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11452 SPACE CENTER BLVD
HOUSTON TX
77059-3599
US

IV. Provider business mailing address

11452 SPACE CENTER BLVD
HOUSTON TX
77059-3599
US

V. Phone/Fax

Practice location:
  • Phone: 832-775-9800
  • Fax: 832-775-9820
Mailing address:
  • Phone: 832-775-9800
  • Fax: 832-775-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00T29R
License Number StateTX

VIII. Authorized Official

Name: THOMAS J. MURPHY
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 832-775-9800