Healthcare Provider Details

I. General information

NPI: 1629608542
Provider Name (Legal Business Name): FONDREN ADVANCED CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 MAIN ST
HOUSTON TX
77030-4509
US

IV. Provider business mailing address

7401 MAIN ST
HOUSTON TX
77030-4509
US

V. Phone/Fax

Practice location:
  • Phone: 713-799-2300
  • Fax: 713-794-3395
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: JACK WILLIAMSON
Title or Position: PRINCIPLE PHYSICIAN
Credential: MD
Phone: 713-799-2300