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General NPI Number Information
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NPI Number | 1063742039
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Entity Type | Organization
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Legal Business Name | PHYSICIANS DIVERSIFIED GROUP, P.A.
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 2802 GARTH RD 110
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City | BAYTOWN
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State | TX
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Zip | 77521-3900
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Country | US
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Telephone | 281-422-5500
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Fax | 281-422-5560
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Provider Business Mailing Address
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Address Line | 4810 N PINE BROOK WAY
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City | HOUSTON
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State | TX
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Zip | 77059-3160
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Country | US
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Telephone | 281-422-5500
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Fax | 281-422-5560
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GHYASUDDIN SYED
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Credential | M.D.
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Telephone | 281-422-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | L3493
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | L3493
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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