=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508809245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN N. PAPADOPOULOS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 10/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19770 KINGSLAND BLVD STE 100
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77094-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-563-9600
-----------------------------------------------------
Fax | 281-646-4351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19770 KINGSLAND BLVD STE 100
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77094-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-563-9600
-----------------------------------------------------
Fax | 281-646-4351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | M8900
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------