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General NPI Number Information
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NPI Number | 1396035762
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Entity Type | Organization
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Legal Business Name | HOUSTON TRAVEL MEDICINE CLINIC
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 2000 CRAWFORD ST SUITE 1105 ST. JOSEPH PROFESSIONAL BUILDING
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City | HOUSTON
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State | TX
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Zip | 77002-9005
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Country | US
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Telephone | 713-652-4900
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Fax | 713-652-4902
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Provider Business Mailing Address
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Address Line | 2000 CRAWFORD ST SUITE 1105 ST. JOSEPH PROFESSIONAL BUILDING
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City | HOUSTON
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State | TX
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Zip | 77002-9005
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Country | US
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Telephone | 713-652-4900
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Fax | 713-652-4902
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BONNIE MARIE WORD
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Credential | MD
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Telephone | 713-652-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | L8234
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License Number State | TX
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