=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801725197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEISSEN PYO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2026
-----------------------------------------------------
Last Update Date | 05/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 UNIVERSITY BLVD
-----------------------------------------------------
City | GALVESTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77555-5303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-772-0764
-----------------------------------------------------
Fax | 409-772-9785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6811 ESCONDIDO DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77083-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | BP10098954
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------