Provider Demographics
NPI:1598964041
Name:LOU, DEREK CHUNTAO (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:CHUNTAO
Last Name:LOU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1201 DAIRY ASHFORD RD.
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079
Mailing Address - Country:US
Mailing Address - Phone:713-932-7290
Mailing Address - Fax:281-741-4544
Practice Address - Street 1:1201 DAIRY ASHFORD RD.
Practice Address - Street 2:SUITE 117
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079
Practice Address - Country:US
Practice Address - Phone:713-932-7290
Practice Address - Fax:281-741-4544
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2018-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01063989A208200000X
TX26513575208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613169Medicare PIN