Healthcare Provider Details

I. General information

NPI: 1669715835
Provider Name (Legal Business Name): AVERY OBLEPIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22815 PARKWALK LN
KATY TX
77494-4451
US

IV. Provider business mailing address

22815 PARKWALK LN
KATY TX
77494-4451
US

V. Phone/Fax

Practice location:
  • Phone: 281-850-5325
  • Fax:
Mailing address:
  • Phone: 281-850-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: