Healthcare Provider Details

I. General information

NPI: 1205952694
Provider Name (Legal Business Name): GTD MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SOUTH MASON ROAD SUITE B1
KATY TX
77450-3863
US

IV. Provider business mailing address

830 SOUTH MASON ROAD SUITE B1
KATY TX
77450-3863
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-5400
  • Fax: 281-392-6096
Mailing address:
  • Phone: 281-392-5400
  • Fax: 281-392-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number40845
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC17745
License Number StateTX

VIII. Authorized Official

Name: MR. GEORGE RUSSELL MORRISON JR.
Title or Position: PRESIDENT/CEO
Credential: BOCCOF
Phone: 281-392-5400