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General NPI Number Information
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NPI Number | 1245501634
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Entity Type | Organization
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Legal Business Name | WOODFAIR FAMILY PRACTICE
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 9896 BISSONNET ST STE 375
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City | HOUSTON
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State | TX
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Zip | 77036-8154
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Country | US
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Telephone | 713-774-0024
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Fax | 713-774-0024
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Provider Business Mailing Address
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Address Line | 9896 BISSONNET #375 9896 BISSONNET #375
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City | HOUSTON
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State | TX
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Zip | 77036-8154
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Country | US
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Telephone | 713-774-0024
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Fax | 713-774-0028
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Authorized Official
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Title or Position | OWNER
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Name | BENNETTE BERGERON
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Credential | ADMINSTRATOR
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Telephone | 713-774-0024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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