Provider Demographics
NPI:1437264728
Name:PRIMOMO, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:PRIMOMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10125 KATY FWY STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1287
Mailing Address - Country:US
Mailing Address - Phone:713-464-6000
Mailing Address - Fax:713-464-6002
Practice Address - Street 1:10125 KATY FWY STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1287
Practice Address - Country:US
Practice Address - Phone:713-464-6000
Practice Address - Fax:713-464-6002
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3252208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L18422Medicare PIN