=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528373271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMER CREEK PHYSICIANS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2010
-----------------------------------------------------
Last Update Date | 08/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11501 NORTH SAM HOUSTON EAST PKWY SUITE B
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-458-9001
-----------------------------------------------------
Fax | 281-458-9002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11501 NORTH SAM HOUSTON PARKWAY EAST SUITE B
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-458-9001
-----------------------------------------------------
Fax | 281-458-9002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DOAN THUY DO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-458-9001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | N5654
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------