Healthcare Provider Details

I. General information

NPI: 1407263239
Provider Name (Legal Business Name): JUSTIN MICHAEL SEGRAVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CAMBRIDGE ST FL 8
HOUSTON TX
77030-4202
US

IV. Provider business mailing address

7200 CAMBRIDGE ST FL 8
HOUSTON TX
77030-4202
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-2400
  • Fax:
Mailing address:
  • Phone: 713-798-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR2014
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberR2014
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: