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General NPI Number Information
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NPI Number | 1689910382
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Entity Type | Organization
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Legal Business Name | PRIMER FAMILY CLINIC
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 7715 STUEBNER AIRLINE RD SUITE D
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City | HOUSTON
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State | TX
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Zip | 77088-6367
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Country | US
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Telephone | 281-447-4600
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Fax | 281-447-4601
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Provider Business Mailing Address
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Address Line | 7715 STUEBNER AIRLINE RD SUITE D
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City | HOUSTON
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State | TX
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Zip | 77088-6367
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Country | US
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Telephone | 281-447-4600
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Fax | 281-447-4601
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MRS. CYNTHIA DIANE GOODMAN
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Credential | M.D.
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Telephone | 281-447-4600
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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 | J1640
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License Number State | TX
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