=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558138412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSTON INSTITUTE OF PLASTIC SURGERY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2023
-----------------------------------------------------
Last Update Date | 01/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 FANNIN ST STE 850
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-678-0019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3313 BARON ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77020-6111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-606-5940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PLASTIC SURGEON
-----------------------------------------------------
Name | DR. GEORGE WASHINGTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 504-606-5940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------