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General NPI Number Information
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NPI Number | 1093908204
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Entity Type | Organization
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Legal Business Name | CHAMPIONS FAMILY PRACTICE, P.A
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 16740 CHAMPION FOREST DR
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City | SPRING
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State | TX
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Zip | 77379-7024
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Country | US
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Telephone | 281-376-2828
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Fax | 281-320-8143
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Provider Business Mailing Address
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Address Line | 16740 CHAMPION FOREST DR
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City | SPRING
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State | TX
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Zip | 77379-7024
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Country | US
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Telephone | 281-376-2828
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Fax | 281-320-8143
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DALBIR S PUREWAL
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Credential | M.D.
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Telephone | 281-376-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | K3405
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License Number State | TX
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