=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124900071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURT L FORGASON MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2025
-----------------------------------------------------
Last Update Date | 08/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14441 MEMORIAL DR STE 6
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-6708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-493-0010
-----------------------------------------------------
Fax | 281-493-3814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14441 MEMORIAL DR STE 6
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-6708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-493-0010
-----------------------------------------------------
Fax | 281-493-3814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. BURT L FORGASON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-493-0010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------