Provider Demographics
NPI:1629283205
Name:GHOUSE, UMERA (MD)
Entity Type:Individual
Prefix:
First Name:UMERA
Middle Name:
Last Name:GHOUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:UMERA
Other - Middle Name:
Other - Last Name:GHOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3320 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6109
Practice Address - Country:US
Practice Address - Phone:214-266-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4427207Q00000X
OH094047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211239309Medicaid
TX211239301Medicaid
TX211239305Medicaid
TX211239306Medicaid
TX211239308Medicaid
TX211239304Medicaid
TX211239307Medicaid
TX211239303Medicaid
TX211239302Medicaid
TX211239308Medicaid
TX211239303Medicaid