Healthcare Provider Details

I. General information

NPI: 1861923443
Provider Name (Legal Business Name): CODY JEU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18220 TOMBALL PKWY STE 155
HOUSTON TX
77070-4350
US

IV. Provider business mailing address

14140 SOUTHWEST FWY STE 200
SUGAR LAND TX
77478-3842
US

V. Phone/Fax

Practice location:
  • Phone: 281-469-5400
  • Fax: 281-469-2337
Mailing address:
  • Phone: 281-649-7000
  • Fax: 281-240-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberT8565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: