Provider Demographics
NPI:1508865783
Name:HOUSTON, JOHN T (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:HOUSTON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1102 TRIPLETT ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3104
Mailing Address - Country:US
Mailing Address - Phone:270-926-8828
Mailing Address - Fax:270-926-0760
Practice Address - Street 1:1102 TRIPLETT ST
Practice Address - Street 2:STE 1000
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3104
Practice Address - Country:US
Practice Address - Phone:270-926-8828
Practice Address - Fax:270-926-0760
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-09-14
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Provider Licenses
StateLicense IDTaxonomies
KY21411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64214117Medicaid
KY1584601Medicare ID - Type Unspecified
C7287Medicare UPIN