=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609826569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSTON INTERNAL MEDICINE SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 09/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7737 BEECHNUT ST SUITE 202
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-773-2255
-----------------------------------------------------
Fax | 713-773-2277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7737 BEECHNUT ST SUITE 202
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-773-2255
-----------------------------------------------------
Fax | 713-773-2277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | JOHNSON AGU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 713-773-2255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | K9007
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------