Healthcare Provider Details
I. General information
NPI: 1285874867
Provider Name (Legal Business Name): FSJ MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/23/2009
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2300 GREEN OAK DR SUITE 150
KINGWOOD TX
77339-2048
US
IV. Provider business mailing address
526 KINGWOOD DR SUITE 421
KINGWOOD TX
77339-4473
US
V. Phone/Fax
- Phone: 832-726-6776
- Fax: 832-262-4628
- Phone: 832-726-6776
- Fax: 832-262-4628
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QA1903X |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| License Number | J2773 |
| License Number State | TX |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208VP0014X |
| Taxonomy | Interventional Pain Medicine Physician |
| License Number | J2773 |
| License Number State | TX |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | J2773 |
| License Number State | TX |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2082S0099X |
| Taxonomy | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician |
| License Number | J2773 |
| License Number State | TX |
| # 5 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QU0200X |
| Taxonomy | Urgent Care Clinic/Center |
| License Number | J2773 |
| License Number State | TX |
VIII. Authorized Official
Name: DR.
FELIX
NABOR
SABATES
JR.
Title or Position: DOCTOR
Credential: M.D
Phone: 713-876-3534