=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215355029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GABRIEL A. MAISLOS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2014
-----------------------------------------------------
Last Update Date | 03/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 SOUTHWEST FWY STE 506
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-1816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-3199
-----------------------------------------------------
Fax | 713-541-5809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7777 SOUTHWEST FWY STE 506
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-1816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-3199
-----------------------------------------------------
Fax | 713-541-5809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GABRIEL A MAISLOS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 713-541-3199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 1576P
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------