=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093909608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE NUNEZ, JR. MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 11/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22999 HIGHWAY 59 # 176
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-358-3702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22999 HIGHWAY 59 # 176
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-358-3702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GEORGE NUNEZ JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-358-3702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | F85044
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------