Healthcare Provider Details

I. General information

NPI: 1609850445
Provider Name (Legal Business Name): BAYLOR PATHOLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W BELLFORT ST SUITE 130
HOUSTON TX
77054-5000
US

IV. Provider business mailing address

PO BOX 4698
HOUSTON TX
77210-4698
US

V. Phone/Fax

Practice location:
  • Phone: 713-481-3544
  • Fax: 713-349-9641
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D0660117
License Number StateTX

VIII. Authorized Official

Name: MR. DAVID TITUS
Title or Position: AUTHORIZED REP
Credential:
Phone: 713-481-3544