MEDICARE: DR. JOHN ANTHONY PRIMOMO 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	208600000X	Surgery Physician	N3252	TX

General Provider Information

NPI Number	:	1437264728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANTHONY PRIMOMO M.D.

Provider Business Mailing Address
First Line	:	10125 KATY FWY STE 106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1287
Country	:	US
Telephone Number	:	713-464-6000
Fax Number	:	713-464-6002

Provider Business Practice Location Address
First Line	:	10125 KATY FWY STE 106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1287
Country	:	US
Telephone Number	:	713-464-6000
Fax Number	:	713-464-6002

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	11/29/2023

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