Healthcare Provider Details

I. General information

NPI: 1235381690
Provider Name (Legal Business Name): EAR, NOSE, THROAT AND ALLERGY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 SOUTHWEST FWY STE 510
HOUSTON TX
77027-7311
US

IV. Provider business mailing address

4140 SOUTHWEST FWY STE 510
HOUSTON TX
77027-7311
US

V. Phone/Fax

Practice location:
  • Phone: 713-621-2556
  • Fax:
Mailing address:
  • Phone: 713-621-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State

VIII. Authorized Official

Name: MAJED IBRAHIM
Title or Position: PRESIDENT
Credential: SURGICAL TEC
Phone: 713-621-2556