Provider Demographics
NPI:1467679514
Name:PERSONAL PHYSICIANS OF SUGAR LAND
Entity Type:Organization
Organization Name:PERSONAL PHYSICIANS OF SUGAR LAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-242-2221
Mailing Address - Street 1:4660 SWEETWATER BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3164
Mailing Address - Country:US
Mailing Address - Phone:281-242-2221
Mailing Address - Fax:281-242-2225
Practice Address - Street 1:4660 SWEETWATER BLVD STE 170
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3164
Practice Address - Country:US
Practice Address - Phone:281-242-2221
Practice Address - Fax:281-242-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067NHOtherBLUE CROSS BLUE SHIELD ID
TX00987ZMedicare ID - Type Unspecified