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General NPI Number Information
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NPI Number | 1366404436
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Entity Type | Individual
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Provider Name | NORTHSTAR MEDICAL CENTER
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 11569 S Wilcrest dr
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City | Houston
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State | TX
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Zip | 77099
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Country | US
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Telephone | 832-245-6996
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Fax | 832-245-6997
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Provider Business Mailing Address
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Address Line | 11569 S Wilcrest Dr
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City | Houston
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State | TX- TEXAS
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Zip | 77099
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Country | US
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Telephone | 832-245-6996
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Fax | 832-245-6997
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology
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License Number | J6305
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License Number State | TX
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