Provider Demographics
NPI:1659319903
Name:BOUTROS, PA
Entity Type:Organization
Organization Name:BOUTROS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-526-5771
Mailing Address - Street 1:12951 SOUTH FREEWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-1923
Mailing Address - Country:US
Mailing Address - Phone:713-526-5771
Mailing Address - Fax:713-526-2036
Practice Address - Street 1:12951 SOUTH FREEWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-1923
Practice Address - Country:US
Practice Address - Phone:713-526-5771
Practice Address - Fax:713-526-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00234XMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER