Healthcare Provider Details

I. General information

NPI: 1952937914
Provider Name (Legal Business Name): MICHAEL PETRUS-JONES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 FAIRMONT PKWY STE 100
PASADENA TX
77504-3013
US

IV. Provider business mailing address

6701 FANNIN ST STE 1540
HOUSTON TX
77030-2613
US

V. Phone/Fax

Practice location:
  • Phone: 128-148-7311
  • Fax:
Mailing address:
  • Phone: 832-824-1170
  • Fax: 832-825-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU1992
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: