Healthcare Provider Details

I. General information

NPI: 1144273103
Provider Name (Legal Business Name): ADRIEN SOWLE SUBORA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOLCOMBE BLVD MD ANDERSON CANCER CENTER - DEPARTMENT OF LEUKEMIA
HOUSTON TX
77030-4000
US

IV. Provider business mailing address

1515 HOLCOMBE BLVD MD ANDERSON CANCER CENTER - DEPARTMENT OF LEUKEMIA
HOUSTON TX
77030-4000
US

V. Phone/Fax

Practice location:
  • Phone: 713-792-6161
  • Fax:
Mailing address:
  • Phone: 713-792-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: