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General NPI Number Information
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NPI Number | 1851729313
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Entity Type | Organization
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Legal Business Name | CONSULTORIO MEDICO HISPANO
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 6692 SOUTHWEST FWY SUITE B
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City | HOUSTON
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State | TX
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Zip | 77074-2210
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Country | US
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Telephone | 713-714-8604
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Fax |
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Provider Business Mailing Address
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Address Line | 6692 SOUTHWEST FWY SUITE B
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City | HOUSTON
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State | TX
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Zip | 77074-2210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | STANTON PACKARD
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Credential | M.D.
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Telephone | 713-714-8604
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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 | J6641
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License Number State | TX
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