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General NPI Number Information
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NPI Number | 1558485789
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Entity Type | Organization
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Legal Business Name | ST. JOHNS PHYSICIAN ASSOCIATES, P.A.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 3139 W HOLCOMBE BLVD #615
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City | HOUSTON
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State | TX
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Zip | 77025-1505
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Country | US
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Telephone | 713-988-8860
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Fax | 713-988-8861
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Provider Business Mailing Address
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Address Line | PO BOX 981095
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City | HOUSTON
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State | TX
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Zip | 77098-8095
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Country | US
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Telephone | 713-988-8860
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Fax | 713-988-8861
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Authorized Official
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Title or Position | MD
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Name | DR. CHENG SAMUEL CHEN
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Credential | MD, PH.D.
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Telephone | 713-988-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | K3125
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License Number State | TX
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