Healthcare Provider Details

I. General information

NPI: 1659618221
Provider Name (Legal Business Name): MANSOUR NAVID ORTHO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PEAKWOOD DR SUITE 3A
HOUSTON TX
77090-2900
US

IV. Provider business mailing address

800 PEAKWOOD DR SUITE 3A
HOUSTON TX
77090-2900
US

V. Phone/Fax

Practice location:
  • Phone: 281-746-3070
  • Fax: 281-970-5118
Mailing address:
  • Phone: 281-746-3070
  • Fax: 281-970-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberL6540
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberL1125
License Number StateTX

VIII. Authorized Official

Name: EDWARD SHAWN MANSOUR
Title or Position: PHYSICIAN/PARTNER
Credential: D.O.
Phone: 281-746-3070