Provider Demographics
NPI:1659372969
Name:BAYSHORE FAMILY PRACTICE P.A.
Entity Type:Organization
Organization Name:BAYSHORE FAMILY PRACTICE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-775-9800
Mailing Address - Street 1:11452 SPACE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3599
Mailing Address - Country:US
Mailing Address - Phone:832-775-9800
Mailing Address - Fax:832-775-9820
Practice Address - Street 1:11452 SPACE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-3599
Practice Address - Country:US
Practice Address - Phone:832-775-9800
Practice Address - Fax:832-775-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00T29R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098132602Medicaid
TX039836401Medicaid
TX085193301Medicaid
TX098341302Medicaid
TXC19727Medicare UPIN
TX81Y721Medicare ID - Type UnspecifiedGLENDA M. GOODINE, M.D.
TX81Y725Medicare ID - Type UnspecifiedMICHAEL GANNON, M.D.
TXB22863Medicare UPIN
TX039836401Medicaid
TXB22866Medicare UPIN
TX87Z036Medicare ID - Type UnspecifiedHAROLD WALTON, M.D.
TX085193301Medicaid
TX81Y720Medicare ID - Type UnspecifiedTHOMAS MURPHY, M.D.
TX00T29RMedicare ID - Type UnspecifiedBAYSHORE FAMILY PRACTICE