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General NPI Number Information
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NPI Number | 1386689958
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Entity Type | Organization
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Legal Business Name | MCGOWEN ST. CHILDREN'S CLINIC & PREVENTIVE MEDICINE INSTITUTE
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2900 SMITH ST STE 101
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City | HOUSTON
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State | TX
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Zip | 77006-3446
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Country | US
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Telephone | 713-655-1006
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Fax | 713-571-9630
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Provider Business Mailing Address
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Address Line | PO BOX 667638
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City | HOUSTON
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State | TX
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Zip | 77266-7638
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Country | US
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Telephone | 713-655-1006
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Fax | 713-571-9630
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Authorized Official
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Title or Position | PHYSICIAN/OWNER/PRES.OF CORPORATION
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Name | DR. GWENDOLYN ELIZABETH BROBBEY
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Credential | M.D.,MPH
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Telephone | 713-655-1006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G0899
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License Number State | TX
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