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General NPI Number Information
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NPI Number | 1639437189
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE ASSOCIATES OF CONROE PLLC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 508 MEDICAL CENTER BLVD SUITE 300
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City | CONROE
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State | TX
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Zip | 77304-2808
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Country | US
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Telephone | 877-943-2823
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 713
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City | CONROE
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State | TX
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Zip | 77305-0713
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Country | US
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Telephone | 877-943-2823
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGG HALLBAUER
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Credential | D.O.
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Telephone | 877-943-2823
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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 | TX
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