Healthcare Provider Details

I. General information

NPI: 1982977872
Provider Name (Legal Business Name): CHILDRENS PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 GESSNER RD STE 2250
HOUSTON TX
77024-2664
US

IV. Provider business mailing address

929 GESSNER RD STE 2250
HOUSTON TX
77024-2664
US

V. Phone/Fax

Practice location:
  • Phone: 713-431-8866
  • Fax: 713-461-0066
Mailing address:
  • Phone: 713-461-8866
  • Fax: 713-461-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberP0027
License Number StateTX

VIII. Authorized Official

Name: PHILEEMON ERIC PAYNE
Title or Position: CRANIOFACIAL SURGEON
Credential: MD
Phone: 713-461-8866