Provider Demographics
NPI:1205016094
Name:WM GRAHAM GUERRIERO, MD P A FACS
Entity Type:Organization
Organization Name:WM GRAHAM GUERRIERO, MD P A FACS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUERRIERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-796-1500
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:STE 1554
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-796-1500
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 1554
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-796-1500
Practice Address - Fax:713-796-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0897208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DP4178OtherMEDICARE RAILROAD
TX0A3103Medicare PIN