Healthcare Provider Details

I. General information

NPI: 1467540625
Provider Name (Legal Business Name): GEORGIE A. EAPEN M.D..
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOLCOMBE BLVD
HOUSTON TX
77030-4000
US

IV. Provider business mailing address

PO BOX 4439
HOUSTON TX
77210-4439
US

V. Phone/Fax

Practice location:
  • Phone: 713-792-6161
  • Fax:
Mailing address:
  • Phone: 713-792-2991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberK6841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: