Provider Demographics
NPI:1598871204
Name:MADRIZ, OMAR I (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:I
Last Name:MADRIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-790-9250
Mailing Address - Fax:713-790-9251
Practice Address - Street 1:915 GESSNER RD STE 725
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2559
Practice Address - Country:US
Practice Address - Phone:713-486-4680
Practice Address - Fax:713-464-4548
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0390208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150272601Medicaid
TX80294KMedicare PIN