MEDICARE: DIVERSIFIED MEDICAL PRACTICES, 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	207R00000X	Internal Medicine Physician	G0049	TX

General Provider Information

NPI Number	:	1750562575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED MEDICAL PRACTICES, P.A.

Provider Business Mailing Address
First Line	:	6301 RICHMOND AVE STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5905
Country	:	US
Telephone Number	:	713-961-7100
Fax Number	:	713-961-3085

Provider Business Practice Location Address
First Line	:	6301 RICHMOND AVE STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5905
Country	:	US
Telephone Number	:	713-961-7100
Fax Number	:	713-961-3085

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICIA DENISE SALVATO
Credential	:	MD
Telephone Number	:	713-961-7100

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	04/01/2021

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