Provider Demographics
NPI:1619373453
Name:TEXAS PHYSICIANS SPECIALIZED MEDICINE PLLC
Entity Type:Organization
Organization Name:TEXAS PHYSICIANS SPECIALIZED MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:KOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-596-1051
Mailing Address - Street 1:3401 W AIRPORT FWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5902
Mailing Address - Country:US
Mailing Address - Phone:214-596-1051
Mailing Address - Fax:214-596-1052
Practice Address - Street 1:3401 W AIRPORT FWY
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5902
Practice Address - Country:US
Practice Address - Phone:214-596-1051
Practice Address - Fax:214-596-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3183208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty