=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730668567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMONE STALLING MD PHD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2018
-----------------------------------------------------
Last Update Date | 01/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 GESSNER RD STE 500
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-2568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-468-0303
-----------------------------------------------------
Fax | 713-468-0307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 GESSNER RD STE 500
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-2568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-468-0303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. SIMONE SUZETTE STALLING
-----------------------------------------------------
Credential | MD, PHD
-----------------------------------------------------
Telephone | 713-468-0303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------