MEDICARE: TEXAS ENDOCRINOLOGY GROUP,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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1558567891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS ENDOCRINOLOGY GROUP,PA

Provider Business Mailing Address
First Line	:	6624 FANNIN ST STE 2380
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2308
Country	:	US
Telephone Number	:	713-800-6212
Fax Number	:	713-800-6241

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST STE 2380
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2308
Country	:	US
Telephone Number	:	713-800-6212
Fax Number	:	713-800-6241

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	DR. CRISTINA BOCCALANDRO
Credential	:	MD MPH
Telephone Number	:	713-800-6212

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	05/08/2008

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