Healthcare Provider Details

I. General information

NPI: 1912913484
Provider Name (Legal Business Name): JOSEPH J OOLUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 PARK GROVE DR STE 310
KATY TX
77450-1580
US

IV. Provider business mailing address

411 PARK GROVE LN SUITE 310
KATY TX
77450-1088
US

V. Phone/Fax

Practice location:
  • Phone: 281-579-5799
  • Fax: 281-579-5798
Mailing address:
  • Phone: 713-464-9100
  • Fax: 713-468-6183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM4410
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM4410
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: