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General NPI Number Information
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NPI Number | 1093065567
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Entity Type | Organization
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Legal Business Name | GULF BANK MEDICAL CENTER
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 302 W GULF BANK RD
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City | HOUSTON
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State | TX
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Zip | 77037-2365
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Country | US
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Telephone | 281-447-7614
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Fax | 281-447-6514
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Provider Business Mailing Address
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Address Line | 302 W GULF BANK RD
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City | HOUSTON
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State | TX
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Zip | 77037-2365
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Country | US
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Telephone | 281-447-7614
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Fax | 281-447-6514
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Authorized Official
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Title or Position | OWNERSHIP/DOCTOR
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Name | DR. JESUS MAYOR JR.
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Credential | M.D. P A
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Telephone | 281-447-7614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | H3116
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License Number State | TX
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