MEDICARE: BAYLOR COLLEGE OF MEDICINE

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	207N00000X	Dermatology Physician

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	:	1629082292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYLOR COLLEGE OF MEDICINE

Provider Business Mailing Address
First Line	:	2 E GREENWAY PLZ
Second Line	:	SUITE 900
City	:	HOUSTON
State	:	TX
Zip	:	77046-0297
Country	:	US
Telephone Number	:	713-798-6131
Fax Number	:	713-798-5535

Provider Business Practice Location Address
First Line	:	1977 BUTLER BLVD
Second Line	:	STE 1425
City	:	HOUSTON
State	:	TX
Zip	:	77030-4101
Country	:	US
Telephone Number	:	713-798-6131
Fax Number	:	713-798-5535

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RICHARD C ALLISON III
Credential	:
Telephone Number	:	713-798-1746

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/06/2013

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Directions to “BAYLOR COLLEGE OF MEDICINE ” Practice Location

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