Healthcare Provider Details

I. General information

NPI: 1487603148
Provider Name (Legal Business Name): WAGIH A GENDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PASADENA BLVD #A
PASADENA TX
77502-2414
US

IV. Provider business mailing address

1430 PASADENA BLVD # A
PASADENA TX
77502-2414
US

V. Phone/Fax

Practice location:
  • Phone: 713-477-0400
  • Fax: 713-477-2711
Mailing address:
  • Phone: 713-477-0400
  • Fax: 713-477-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ9680
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: