Healthcare Provider Details

I. General information

NPI: 1669417507
Provider Name (Legal Business Name): DR ATILLA ERTAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN STE 2208
HUSTON TX
77030
US

IV. Provider business mailing address

6560 FANNIN ST STE 2208
HOUSTON TX
77030-2761
US

V. Phone/Fax

Practice location:
  • Phone: 713-796-0001
  • Fax: 713-793-7661
Mailing address:
  • Phone: 713-794-0001
  • Fax: 713-793-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1036559
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02055
License Number StateTX

VIII. Authorized Official

Name: PROF. ATILLA ERTAN
Title or Position: GASTROENTEROLOGIST
Credential: MD
Phone: 713-794-0001