Provider Demographics
NPI:1477722783
Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES
Other - Org Name:FERTILITY SPECIALISTS OF HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-512-7000
Mailing Address - Street 1:PO BOX 4048
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4048
Mailing Address - Country:US
Mailing Address - Phone:713-512-7000
Mailing Address - Fax:713-512-7561
Practice Address - Street 1:4724 SWEETWATER BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3149
Practice Address - Country:US
Practice Address - Phone:713-512-7000
Practice Address - Fax:713-512-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1047207VE0102X
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0044CGOtherBLUE CROSS BLUE SHIELD
TXCH8922OtherRAILROAD MEDICARE
TX0044CGOtherBLUE CROSS BLUE SHIELD