MEDICARE: DR. GBARANEN B GBAANADOR M.D.

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	H4928	TX
2	208D00000X	General Practice Physician	H4928	TX

General Provider Information

NPI Number	:	1063492254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GBARANEN B GBAANADOR M.D.

Provider Business Mailing Address
First Line	:	8449 W BELLFORT ST STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2246
Country	:	US
Telephone Number	:	713-541-9886
Fax Number	:	713-541-9072

Provider Business Practice Location Address
First Line	:	8449 W BELLFORT ST STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2246
Country	:	US
Telephone Number	:	713-541-9886
Fax Number	:	713-541-9072

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/23/2007

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