Provider Demographics
NPI:1518364157
Name:COLLEGE PARK ANESTHESIA ASSOCIATES PA
Entity Type:Organization
Organization Name:COLLEGE PARK ANESTHESIA ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-345-2743
Mailing Address - Street 1:8524 HIGHWAY 6 N
Mailing Address - Street 2:342
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2103
Mailing Address - Country:US
Mailing Address - Phone:281-345-2743
Mailing Address - Fax:
Practice Address - Street 1:8524 HIGHWAY 6 N
Practice Address - Street 2:342
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2103
Practice Address - Country:US
Practice Address - Phone:281-345-2743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty