Provider Demographics
NPI:1457672107
Name:GULFTON MEDICAL CLINIC
Entity Type:Organization
Organization Name:GULFTON MEDICAL CLINIC
Other - Org Name:GULFTON MEDICAL CLINIC PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:713-523-0111
Mailing Address - Street 1:6306 GULFTON ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1117
Mailing Address - Country:US
Mailing Address - Phone:713-523-0111
Mailing Address - Fax:713-484-7204
Practice Address - Street 1:6306 GULFTON ST
Practice Address - Street 2:STE. 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1117
Practice Address - Country:US
Practice Address - Phone:713-523-0111
Practice Address - Fax:713-484-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGMedicare PIN