Provider Demographics
NPI:1407857725
Name:RUMPH, GREGORY EVAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:EVAN
Last Name:RUMPH
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 1:1003 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR LAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77586-4528
Mailing Address - Country:US
Mailing Address - Phone:281-326-3426
Mailing Address - Fax:
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:BEN TAUB GENERAL HOSPITAL
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-873-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026653207P00000X, 207R00000X
TXN0420207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1065064Medicaid
LA1065064Medicaid