Healthcare Provider Details

I. General information

NPI: 1811483803
Provider Name (Legal Business Name): MEMORIAL ADVANCED RHEUMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 12/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 FROSTWOOD DR STE 208
HOUSTON TX
77024-2426
US

IV. Provider business mailing address

902 FROSTWOOD DR STE 208
HOUSTON TX
77024-2426
US

V. Phone/Fax

Practice location:
  • Phone: 713-266-1946
  • Fax:
Mailing address:
  • Phone: 713-266-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DIANNE E WOLLASTON
Title or Position: PRESIDENT
Credential: MD
Phone: 713-266-1946