Healthcare Provider Details

I. General information

NPI: 1972558674
Provider Name (Legal Business Name): ROBERT E HOUSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 ROGERS RD
NASSAWADOX VA
23413-1016
US

IV. Provider business mailing address

PO BOX 137
NASSAWADOX VA
23413-0137
US

V. Phone/Fax

Practice location:
  • Phone: 757-753-1632
  • Fax:
Mailing address:
  • Phone: 757-753-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number36115035
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101239446
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22614
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101239446
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: