Provider Demographics
NPI:1447207592
Name:SISON, BLANDINA (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANDINA
Middle Name:
Last Name:SISON
Suffix:
Gender:F
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:PO BOX 11178
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-1178
Mailing Address - Country:US
Mailing Address - Phone:832-698-4377
Mailing Address - Fax:832-698-4430
Practice Address - Street 1:18310 TOMBALL PARKWAY
Practice Address - Street 2:STE.200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:832-698-4377
Practice Address - Fax:832-698-4430
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100657902Medicaid
TX080136656OtherMEDICARE RAILROAD
TX080136656OtherMEDICARE RAILROAD
TX80264NMedicare PIN