Healthcare Provider Details

I. General information

NPI: 1174708564
Provider Name (Legal Business Name): PEARLAND ENT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 COUNTY ROAD 90 STE 123
PEARLAND TX
77584-4891
US

IV. Provider business mailing address

2225 COUNTY ROAD 90 SUITE 123
PEARLAND TX
77584-4890
US

V. Phone/Fax

Practice location:
  • Phone: 281-412-6100
  • Fax: 281-412-2423
Mailing address:
  • Phone: 281-412-6100
  • Fax: 281-412-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OMID ABBASSI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD-PHD
Phone: 281-412-6100