=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235267493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANLEY J POOL MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 09/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8951 RUTHBY ST STE 5
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77061-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-649-0041
-----------------------------------------------------
Fax | 713-645-1916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8951 RUTHBY ST STE 5
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77061-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-649-0041
-----------------------------------------------------
Fax | 713-645-1916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STANLEY J POOL MD PA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 713-649-0041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | F0286
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | F0286
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------