Provider Demographics
NPI:1376677591
Name:EMILE MATHURIN, JR., M.D., P.A.,
Entity Type:Organization
Organization Name:EMILE MATHURIN, JR., M.D., P.A.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHURIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-446-4429
Mailing Address - Street 1:PO BOX 5352
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-5352
Mailing Address - Country:US
Mailing Address - Phone:281-446-4429
Mailing Address - Fax:
Practice Address - Street 1:9810 FM-1960 BYPASS RD W
Practice Address - Street 2:SUITE 115
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:281-446-4429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX250007825OtherRAIL ROAD MEDICARE
TX182619001Medicaid
UT182746300OtherFEDERAL WORKERS COMP
TX0028QSOtherBLUE CROSS BLUE SHIELD
TX182619001Medicaid
TX0028QSOtherBLUE CROSS BLUE SHIELD