Healthcare Provider Details

I. General information

NPI: 1477136448
Provider Name (Legal Business Name): EMMALEE BERGEZ HOLT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMALEE MITCHELL BERGEZ

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 500
HOUSTON TX
77030-3005
US

IV. Provider business mailing address

6431 FANNIN STREET MSB 3.151
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax: 713-500-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU8740
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: