Healthcare Provider Details

I. General information

NPI: 1407397847
Provider Name (Legal Business Name): JUSTIN A SCHMIDGALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2017
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN ST
HOUSTON TX
77030-2703
US

IV. Provider business mailing address

2190 NORTH LOOP W STE 250
HOUSTON TX
77018-8016
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-7558
  • Fax: 713-363-9706
Mailing address:
  • Phone: 713-441-7558
  • Fax: 713-363-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberU5510
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: