Provider Demographics
NPI:1508042805
Name:PEARLAND PROFESSIONAL GROUP P.A.
Entity Type:Organization
Organization Name:PEARLAND PROFESSIONAL GROUP P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-997-7333
Mailing Address - Street 1:2425 COUNTY ROAD 90
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4883
Mailing Address - Country:US
Mailing Address - Phone:281-997-7333
Mailing Address - Fax:281-485-1146
Practice Address - Street 1:2425 COUNTY ROAD 90
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4883
Practice Address - Country:US
Practice Address - Phone:281-997-7333
Practice Address - Fax:281-485-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127061301Medicaid
TX8837N1Medicare UPIN