Healthcare Provider Details

I. General information

NPI: 1063774628
Provider Name (Legal Business Name): ANDREW GRATZON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18400 KATY FWY STE 500
HOUSTON TX
77094-1287
US

IV. Provider business mailing address

18400 KATY FWY STE 500
HOUSTON TX
77094-1287
US

V. Phone/Fax

Practice location:
  • Phone: 832-522-8400
  • Fax: 832-522-8401
Mailing address:
  • Phone: 832-522-8400
  • Fax: 832-522-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberT1080
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: