Healthcare Provider Details

I. General information

NPI: 1205082153
Provider Name (Legal Business Name): HOUSTON PLASTIC AND RECONSTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 E MEDICAL CENTER BLVD
WEBSTER TX
77598-4326
US

IV. Provider business mailing address

575 E MEDICAL CENTER BLVD
WEBSTER TX
77598-4326
US

V. Phone/Fax

Practice location:
  • Phone: 281-282-9555
  • Fax:
Mailing address:
  • Phone: 281-282-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMMY SIU
Title or Position: PRACTICE MANAGER
Credential:
Phone: 281-282-9555