Healthcare Provider Details

I. General information

NPI: 1821523952
Provider Name (Legal Business Name): JEAN GHOSN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14023 SOUTHWEST FWY
SUGAR LAND TX
77478-3550
US

IV. Provider business mailing address

3006 SCHOOL ST
NEEDVILLE TX
77461-8443
US

V. Phone/Fax

Practice location:
  • Phone: 281-325-4100
  • Fax: 281-325-4292
Mailing address:
  • Phone: 979-793-4114
  • Fax: 979-793-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS4764
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS4764
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: