Provider Demographics
NPI:1518219104
Name:EAST HOUSTON PHYSICIANS GROUP, PA
Entity Type:Organization
Organization Name:EAST HOUSTON PHYSICIANS GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:KILLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-330-0766
Mailing Address - Street 1:PO BOX 96706
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77213-6706
Mailing Address - Country:US
Mailing Address - Phone:713-330-0766
Mailing Address - Fax:713-330-0794
Practice Address - Street 1:11821 EAST FWY STE 175
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1960
Practice Address - Country:US
Practice Address - Phone:713-330-0766
Practice Address - Fax:877-862-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty