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General NPI Number Information
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NPI Number | 1427013978
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Entity Type | Organization
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Legal Business Name | NORTHWEST INFECTIOUS DISEASE AND TRAVEL MEDICINE, PA
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 5509 CORNISH ST
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City | HOUSTON
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State | TX
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Zip | 77007-4303
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Country | US
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Telephone | 832-831-5089
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Fax | 713-360-7715
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Provider Business Mailing Address
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Address Line | 5509 CORNISH ST.
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City | HOUSTON
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State | TX
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Zip | 77007-4303
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Country | US
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Telephone | 832-831-5089
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Fax | 713-360-7715
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PORNTHEP WATTANAMANO
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Credential | MD
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Telephone | 713-384-3229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | L5950
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License Number State | TX
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