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General NPI Number Information
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NPI Number | 1659618221
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Entity Type | Organization
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Legal Business Name | MANSOUR NAVID ORTHO PA
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 800 PEAKWOOD DR SUITE 3A
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City | HOUSTON
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State | TX
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Zip | 77090-2900
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Country | US
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Telephone | 281-746-3070
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Fax | 281-970-5118
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Provider Business Mailing Address
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Address Line | 800 PEAKWOOD DR SUITE 3A
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City | HOUSTON
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State | TX
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Zip | 77090-2900
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Country | US
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Telephone | 281-746-3070
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Fax | 281-970-5118
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Authorized Official
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Title or Position | PHYSICIAN/PARTNER
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Name | EDWARD SHAWN MANSOUR
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Credential | D.O.
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Telephone | 281-746-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | L6540
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | L1125
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License Number State | TX
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