Healthcare Provider Details

I. General information

NPI: 1801835749
Provider Name (Legal Business Name): TASO MOUGOURIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 POST OAK PLACE DR SUITE 130
HOUSTON TX
77027-3164
US

IV. Provider business mailing address

4543 WEDGEWOOD DR
BELLAIRE TX
77401-3105
US

V. Phone/Fax

Practice location:
  • Phone: 713-960-8008
  • Fax: 713-960-0965
Mailing address:
  • Phone: 832-778-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL9377
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: