MEDICARE: RAMLAT IDRIS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	M7710	TX
2	208000000X	Pediatrics Physician	M7710	TX
3	363A00000X	Physician Assistant
4	363A00000X	Physician Assistant	PA11787	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043746225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMLAT IDRIS PA

Provider Business Mailing Address
First Line	:	14201 E SAM HOUSTON PKWY N STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-6495
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14201 E SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-5549
Country	:	US
Telephone Number	:	713-338-6565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2017
Last Update Date	:	09/17/2024

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Directions to “ RAMLAT IDRIS PA” Practice Location

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