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General NPI Number Information
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NPI Number | 1730412271
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Entity Type | Organization
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Legal Business Name | TEXAS FAMILY MEDICINE CENTER, PA
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 506 GRAHAM DR SUITE 200
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City | TOMBALL
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State | TX
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Zip | 77375-3346
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Country | US
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Telephone | 281-255-3838
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Fax | 281-255-3788
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Provider Business Mailing Address
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Address Line | 506 GRAHAM DR SUITE 200
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City | TOMBALL
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State | TX
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Zip | 77375-3346
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Country | US
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Telephone | 281-255-3838
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Fax | 281-255-3788
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Authorized Official
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Title or Position | OWNERS
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Name | JASON & CANDICE DEMATTIA
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Credential | MD
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Telephone | 281-255-3838
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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 | M2305
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M2306
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License Number State | TX
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