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NPI Code Detail

MEDICARE: YVE THALLER HUTTENBACH M.D.

MEDICARE: YVE THALLER HUTTENBACH 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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianK8917TX

General Provider Information

NPI Number : 1760487169
Entity Type Code : Individual
Provider Name (Legal Business Name) : YVE THALLER HUTTENBACH M.D.
Provider Business Mailing Address
First Line : PO BOX 4677
Second Line :
City : HOUSTON
State : TX
Zip : 77210-4677
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 504 MEDICAL CENTER BLVD
Second Line :
City : CONROE
State : TX
Zip : 77304-2808
Country : US
Telephone Number : 713-481-3544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 03/19/2009

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