Healthcare Provider Details

I. General information

NPI: 1710490008
Provider Name (Legal Business Name): UT PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17510 W GRAND PKWY S STE 450
SUGAR LAND TX
77479-2650
US

IV. Provider business mailing address

PO BOX 301173
DALLAS TX
75303-1173
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW CASAS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 832-325-7317