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General NPI Number Information
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NPI Number | 1093131542
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Entity Type | Organization
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Legal Business Name | WAYNE MOLDOVAN MD PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 6550 FANNIN ST SUITE 2415
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City | HOUSTON
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State | TX
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Zip | 77030-2717
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Country | US
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Telephone | 713-790-0911
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Fax |
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Provider Business Mailing Address
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Address Line | 6550 FANNIN ST SUITE 2415
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City | HOUSTON
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State | TX
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Zip | 77030-2717
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Country | US
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Telephone | 713-790-0911
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WAYNE SCOTT MOLDOVAN
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Credential | MD
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Telephone | 713-790-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | P8163
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License Number State | TX
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