Healthcare Provider Details

I. General information

NPI: 1225275704
Provider Name (Legal Business Name): PLENARY MUA INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 YORKTOWN ST SUITE 209
HOUSTON TX
77056-4570
US

IV. Provider business mailing address

2301 YORKTOWN ST SUITE 209
HOUSTON TX
77056-4570
US

V. Phone/Fax

Practice location:
  • Phone: 713-960-8575
  • Fax: 713-960-8594
Mailing address:
  • Phone: 713-960-8575
  • Fax: 713-960-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number6213
License Number StateTX

VIII. Authorized Official

Name: DR. DONALD W SMITH
Title or Position: PROVIDER
Credential: MD
Phone: 713-960-8575