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General NPI Number Information
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NPI Number | 1245788629
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Entity Type | Organization
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Legal Business Name | BEAUMONT PRIMARY HEALTHCARE, PLLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 3510 PRESCOTT DR
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City | BEAUMONT
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State | TX
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Zip | 77706-6349
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Country | US
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Telephone | 248-802-9174
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 PRESCOTT DR
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City | BEAUMONT
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State | TX
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Zip | 77706-6349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARISSA BANATWALA CURRY
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Credential | M.D.
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Telephone | 248-802-9174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M7928
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License Number State | TX
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