Healthcare Provider Details

I. General information

NPI: 1831179241
Provider Name (Legal Business Name): LONDON GOHEL JOINT VENTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 MAIN ST
HOUSTON TX
77030-4509
US

IV. Provider business mailing address

1415 NORTH LOOP W STE 240
HOUSTON TX
77008-1677
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-7788
  • Fax: 281-359-7888
Mailing address:
  • Phone: 713-426-4010
  • Fax: 713-426-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY LONDON
Title or Position: JOINT VENTURER
Credential: M.D.
Phone: 713-426-4010