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General NPI Number Information
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NPI Number | 1033214093
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Entity Type | Organization
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Legal Business Name | JOHN C. HAIRSTON, M.D., P.A.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 16659 SOUTHWEST FWY MEDICAL OFFICE BLDG II, STE 225
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City | SUGAR LAND
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State | TX
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Zip | 77479-2375
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Country | US
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Telephone | 281-313-7878
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Fax | 281-313-7880
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Provider Business Mailing Address
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Address Line | 16659 SOUTHWEST FWY MEDICAL OFFICE BLDG II, STE 225
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City | SUGAR LAND
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State | TX
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Zip | 77479-2375
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Country | US
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Telephone | 281-313-7878
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Fax | 281-313-7880
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JOHN C. HAIRSTON
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Credential | M.D.
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Telephone | 281-313-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | L4417
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License Number State | TX
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