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1154344596

NPI Code Detail

MEDICARE: CANAL FAMILY AND INDUSTRIAL MEDICINE P.A.

MEDICARE: CANAL FAMILY AND INDUSTRIAL MEDICINE P.A.

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10011602	OTHER	TX	DUARTE AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7948658	OTHER	TX	MONCAYO AETNA
6	8S0531	OTHER	TX	BLUE CROSS MONCAYO
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7893532	OTHER	TX	DUARTE AETNA
10	8S0530	OTHER	TX	BLUE CROSS DUARTE

General Provider Information

NPI Number	:	1154344596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANAL FAMILY AND INDUSTRIAL MEDICINE P.A.

Provider Business Mailing Address
First Line	:	3003 NAVIGATION BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1239
Country	:	US
Telephone Number	:	713-223-4466
Fax Number	:	713-223-1571

Provider Business Practice Location Address
First Line	:	3003 NAVIGATION BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1239
Country	:	US
Telephone Number	:	713-223-4466
Fax Number	:	713-223-1571

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JAIME E. DUARTE
Credential	:	M.D.
Telephone Number	:	713-223-4466

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/08/2011

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Directions to “CANAL FAMILY AND INDUSTRIAL MEDICINE P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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