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General NPI Number Information
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NPI Number | 1033361936
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Entity Type | Organization
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Legal Business Name | TARA L WEGRYN MD PA
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 6400 FANNIN ST SUITE 2295
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City | HOUSTON
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State | TX
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Zip | 77030-1521
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Country | US
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Telephone | 713-791-9778
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Fax | 713-791-9401
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Provider Business Mailing Address
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Address Line | 5116 BISSONNET ST PMB 202
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City | BELLAIRE
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State | TX
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Zip | 77401-4007
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Country | US
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Telephone | 713-791-9778
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Fax | 713-791-9401
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Authorized Official
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Title or Position | OWNER
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Name | TARA L WEGRYN
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Credential | MD
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Telephone | 713-791-9778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J1425
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License Number State | TX
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