Provider Demographics
NPI:1659313211
Name:BELLAIRE DOCTORS
Entity Type:Organization
Organization Name:BELLAIRE DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TSAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-772-8885
Mailing Address - Street 1:7850 PARKWOOD CIRCLE DR
Mailing Address - Street 2:A-6
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-6759
Mailing Address - Country:US
Mailing Address - Phone:713-772-8885
Mailing Address - Fax:713-772-7825
Practice Address - Street 1:7850 PARKWOOD CIRCLE DR
Practice Address - Street 2:A-6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-6759
Practice Address - Country:US
Practice Address - Phone:713-772-8885
Practice Address - Fax:713-772-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096478502Medicaid
TX0020QDOtherBLUE CROSS BLUE SHIELD
TX00Y543Medicare PIN