Healthcare Provider Details

I. General information

NPI: 1528070182
Provider Name (Legal Business Name): TOMBALL UROLOGY ASSOCIATES,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 GRAHAM DR STE. A
TOMBALL TX
77375-6408
US

IV. Provider business mailing address

919 GRAHAM DR STE. A
TOMBALL TX
77375-6408
US

V. Phone/Fax

Practice location:
  • Phone: 281-290-9800
  • Fax: 281-290-9824
Mailing address:
  • Phone: 281-290-9800
  • Fax: 281-290-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. LOIS A. FLECK
Title or Position: PRACTICE MANAAGER
Credential:
Phone: 281-290-9800