Provider Demographics
NPI:1114415528
Name:TOPS DANIELLE ANDRY, MD, PLLC
Entity Type:Organization
Organization Name:TOPS DANIELLE ANDRY, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRY WIJAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-573-0479
Mailing Address - Street 1:4306 YOAKUM BLVD STE 520
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5883
Mailing Address - Country:US
Mailing Address - Phone:225-573-0479
Mailing Address - Fax:
Practice Address - Street 1:4306 YOAKUM BLVD STE 520
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006
Practice Address - Country:US
Practice Address - Phone:225-573-0479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5693208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty