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General NPI Number Information
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NPI Number | 1558594515
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Entity Type | Organization
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Legal Business Name | PIN OAK MEDICAL CLINIC OF KATY
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 19255 PARK ROW STE 203
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City | HOUSTON
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State | TX
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Zip | 77084-7310
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Country | US
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Telephone | 281-646-8450
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Fax | 888-880-7753
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Provider Business Mailing Address
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Address Line | 777 S FRY RD SUITE 205
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City | KATY
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State | TX
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Zip | 77450-2244
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Country | US
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Telephone | 281-646-8450
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. LYNN R. GIBBS
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Credential | MD
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Telephone | 281-646-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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