Provider Demographics
NPI:1053330225
Name:KERAGA, GLORIA T
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:T
Last Name:KERAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14214 N SUDDLEY CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3572
Mailing Address - Country:US
Mailing Address - Phone:281-580-0046
Mailing Address - Fax:281-580-4179
Practice Address - Street 1:3303 FM 1960 RD W
Practice Address - Street 2:SUITE #250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3615
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF89142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128788003Medicaid
TX89401SOtherBLUE CROSS BLUE SHIELD
TX8F1811OtherBLUE CROSS BLUE SHIELD
TX128788004Medicaid
TX260044876OtherRAIL ROAD
TX128788002Medicaid
TXSK90OtherHMO
TX89401SOtherBLUE CROSS BLUE SHIELD
TX260044876OtherRAIL ROAD
TX128788002Medicaid