=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205016094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WM GRAHAM GUERRIERO, MD P A FACS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2007
-----------------------------------------------------
Last Update Date | 11/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6560 FANNIN ST STE 1554
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-796-1500
-----------------------------------------------------
Fax | 713-796-1838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6560 FANNIN ST STE 1554
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-796-1500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM G GUERRIERO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-796-1500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | D0897
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------