Healthcare Provider Details

I. General information

NPI: 1255416855
Provider Name (Legal Business Name): SEAN BOUTROS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/30/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 KATY FWY STE 600
HOUSTON TX
77055-7468
US

IV. Provider business mailing address

9230 KATY FWY STE 600
HOUSTON TX
77055-7468
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-0700
  • Fax: 713-791-0703
Mailing address:
  • Phone: 713-791-0700
  • Fax: 713-791-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN BOUTROS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 713-791-0700