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General NPI Number Information
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NPI Number | 1346932480
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Entity Type | Organization
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Legal Business Name | BAYLOR MEDICINE OUTPATIENT RADIOLOGY
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 2457 S BRAESWOOD BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4305
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Country | US
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Telephone | 713-798-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BAYLOR PLZ # 2GR900
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City | HOUSTON
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State | TX
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Zip | 77030-3411
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Country | US
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Telephone | 714-798-1750
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RICHARD C ALLISON
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Credential |
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Telephone | 713-798-1746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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