Healthcare Provider Details

I. General information

NPI: 1194789974
Provider Name (Legal Business Name): WILLOWBROOK CARDIOVASCULAR ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13300 HARGRAVE RD STE 500
HOUSTON TX
77070-4373
US

IV. Provider business mailing address

13300 HARGRAVE RD STE 500
HOUSTON TX
77070-4373
US

V. Phone/Fax

Practice location:
  • Phone: 281-890-4848
  • Fax: 281-890-4885
Mailing address:
  • Phone: 281-890-4848
  • Fax: 281-890-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number207RC0001X
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number207RI0011X
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number207RC0000X
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN CHARLES ISAAC
Title or Position: CHIEF FINACIAL OFFICER
Credential: M.D,
Phone: 281-890-4848