Provider Demographics
NPI:1144316423
Name:KLEIN, MERVYN J (MD)
Entity type:Individual
Prefix:
First Name:MERVYN
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2209
Mailing Address - Country:US
Mailing Address - Phone:713-442-2400
Mailing Address - Fax:
Practice Address - Street 1:1530 DAVID SEARLES BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3916
Practice Address - Country:US
Practice Address - Phone:713-806-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099498004Medicaid
TX099498001Medicaid
TX099498006Medicaid
TX099498005Medicaid
TX099498004Medicaid
TX80326GMedicare PIN
TX8877N6Medicare PIN
TX099498006Medicaid