Provider Demographics
NPI:1407810377
Name:DUCHMAN, STANLEY MATHIAS (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:MATHIAS
Last Name:DUCHMAN
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 1:6560 FANNIN ST STE 620
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2725
Mailing Address - Country:US
Mailing Address - Phone:713-791-1978
Mailing Address - Fax:713-791-1870
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2725
Practice Address - Country:US
Practice Address - Phone:713-791-1978
Practice Address - Fax:713-791-1870
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8524207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ8524OtherPHYSICIAN LICENSE
TX113615808Medicaid
TXG21749Medicare UPIN
TX113615808Medicaid