Healthcare Provider Details

I. General information

NPI: 1497913800
Provider Name (Legal Business Name): ANKUR D MEHTA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 LONG POINT RD SUITE 502
HOUSTON TX
77055-3040
US

IV. Provider business mailing address

8830 LONG POINT RD SUITE: 502
HOUSTON TX
77055-3040
US

V. Phone/Fax

Practice location:
  • Phone: 832-849-0909
  • Fax:
Mailing address:
  • Phone: 832-849-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberP0097
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberP0097
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: