Provider Demographics
NPI:1003008707
Name:TRAVEL MEDICINE OF SUGAR LAND
Entity Type:Organization
Organization Name:TRAVEL MEDICINE OF SUGAR LAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-494-4004
Mailing Address - Street 1:4660 SWEETWATER BLVD
Mailing Address - Street 2:SUITE #190
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3166
Mailing Address - Country:US
Mailing Address - Phone:281-494-4004
Mailing Address - Fax:281-494-8899
Practice Address - Street 1:4660 SWEETWATER BLVD
Practice Address - Street 2:SUITE #190
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3166
Practice Address - Country:US
Practice Address - Phone:281-494-4004
Practice Address - Fax:281-494-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0904174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty