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General NPI Number Information
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NPI Number | 1760488241
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Entity Type | Organization
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Legal Business Name | EAST HOUSTON ORTHOPEDICS & SPORTS MEDICINE, P.A.
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 12930 EAST FWY
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City | HOUSTON
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State | TX
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Zip | 77015-5710
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Country | US
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Telephone | 713-453-6909
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Fax | 713-453-7627
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Provider Business Mailing Address
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Address Line | 12930 EAST FWY
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City | HOUSTON
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State | TX
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Zip | 77015-5710
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Country | US
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Telephone | 713-453-6909
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Fax | 713-453-7627
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE ROGER WEINER
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Credential | M.D.
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Telephone | 713-453-6909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E8228
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License Number State | TX
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