=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497746812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GULCHIN A ERGUN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2005
-----------------------------------------------------
Last Update Date | 09/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6560 FANNIN ST STE 1160
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-933-2650
-----------------------------------------------------
Fax | 713-933-2653
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4346 DEPT 540
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77210-4346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-933-2650
-----------------------------------------------------
Fax | 713-933-2653
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | K4886
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------