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General NPI Number Information
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NPI Number | 1679722425
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Entity Type | Organization
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Legal Business Name | S.G. GHIDE, M.D,, P.A.
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 1120 MEDICAL PLAZA DR STE 310
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City | SHENANDOAH
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State | TX
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Zip | 77380-3242
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Country | US
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Telephone | 281-732-5952
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Fax | 281-377-4733
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Provider Business Mailing Address
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Address Line | PO BOX 9840
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City | THE WOODLANDS
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State | TX
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Zip | 77387-6840
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Country | US
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Telephone | 281-732-5952
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Fax | 281-377-4733
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Authorized Official
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Title or Position | CREDENTIALING/ADMINISTRATION
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Name | MR. SUSAN E WIESNER
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Credential |
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Telephone | 281-851-6431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | K9282
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License Number State | TX
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