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General NPI Number Information
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NPI Number | 1275922668
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Entity Type | Organization
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Legal Business Name | GULF COAST SPINE SPECIALTIES
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 4120 SOUTHWEST FWY 200
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City | HOUSTON
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State | TX
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Zip | 77027-7339
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Country | US
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Telephone | 713-796-3209
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Fax | 713-583-1841
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Provider Business Mailing Address
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Address Line | 4120 SOUTHWEST FWY 200
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City | HOUSTON
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State | TX
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Zip | 77027-7339
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Country | US
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Telephone | 713-796-3209
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Fax | 713-583-1841
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KENNETH ALO
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Credential |
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Telephone | 713-796-3209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H7865
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License Number State | TX
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