Healthcare Provider Details

I. General information

NPI: 1275619082
Provider Name (Legal Business Name): PASADENA GASTROENTEROLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6243 FAIRMONT PKWY STE 203A
PASADENA TX
77505-4047
US

IV. Provider business mailing address

4001 PRESTON AVE SUITE 125
PASADENA TX
77505-2069
US

V. Phone/Fax

Practice location:
  • Phone: 713-946-9513
  • Fax: 713-946-7210
Mailing address:
  • Phone: 713-946-9513
  • Fax: 713-946-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberF3457
License Number StateTX

VIII. Authorized Official

Name: KAREN RAINES
Title or Position: ADMIN
Credential:
Phone: 713-946-9513