Healthcare Provider Details

I. General information

NPI: 1982950549
Provider Name (Legal Business Name): FARAH EBONI MCCORVEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23960 KATY FREEWAY SUITE 300
KATY TX
77494
US

IV. Provider business mailing address

23960 KATY FREEWAY SUITE 300
KATY TX
77494
US

V. Phone/Fax

Practice location:
  • Phone: 281-347-0080
  • Fax: 281-347-0081
Mailing address:
  • Phone: 281-347-0080
  • Fax: 281-347-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ4463
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: