Provider Demographics
NPI:1265643555
Name:PHYSICIAN MEDICAL SPA & LASER CENTER PA.
Entity Type:Organization
Organization Name:PHYSICIAN MEDICAL SPA & LASER CENTER PA.
Other - Org Name:CYPRESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAJWAR
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:281-469-4000
Mailing Address - Street 1:11811 FM 1960 RD W
Mailing Address - Street 2:STE.198
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3827
Mailing Address - Country:US
Mailing Address - Phone:281-469-4000
Mailing Address - Fax:281-469-4126
Practice Address - Street 1:11811 FM 1960 RD W
Practice Address - Street 2:STE.198
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3827
Practice Address - Country:US
Practice Address - Phone:281-469-4000
Practice Address - Fax:281-469-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty