Healthcare Provider Details

I. General information

NPI: 1285043679
Provider Name (Legal Business Name): FONDREN ORTHOPEDIC GROUP L.L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12835 GULF FWY
HOUSTON TX
77034-4807
US

IV. Provider business mailing address

7401 S. MAIN
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 713-436-3488
  • Fax: 713-436-3860
Mailing address:
  • Phone: 713-799-2300
  • Fax: 713-794-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PEGGY J PIERCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-794-3339