Provider Demographics
NPI:1295027183
Name:BOUTROS SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:BOUTROS SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-791-0700
Mailing Address - Street 1:6400 FANNIN ST STE 2290
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1543
Mailing Address - Country:US
Mailing Address - Phone:713-791-0700
Mailing Address - Fax:713-791-0703
Practice Address - Street 1:6400 FANNIN ST STE 2290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1543
Practice Address - Country:US
Practice Address - Phone:713-791-0700
Practice Address - Fax:713-791-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM26332082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB141773Medicare PIN