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General NPI Number Information
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NPI Number | 1093188443
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Entity Type | Organization
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Legal Business Name | TRICIA PUNSALAN MD PA
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 500 MEDICAL CENTER BLVD SUITE 100
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City | CONROE
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State | TX
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Zip | 77304-2889
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Country | US
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Telephone | 936-788-8084
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Fax | 936-788-8054
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Provider Business Mailing Address
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Address Line | 500 MEDICAL CENTER BLVD SUITE 100
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City | CONROE
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State | TX
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Zip | 77304-2889
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Country | US
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Telephone | 936-788-8084
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Fax | 936-788-8054
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRICIA L PUNSALAN
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Credential | M.D.
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Telephone | 936-788-8084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N2740
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License Number State | TX
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