Provider Demographics
NPI:1760427801
Name:EAST HOUSTON UROLOGY PA
Entity Type:Organization
Organization Name:EAST HOUSTON UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-637-8200
Mailing Address - Street 1:P O BOX 1437 DEPT 00
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1437
Mailing Address - Country:US
Mailing Address - Phone:713-637-8200
Mailing Address - Fax:713-637-8203
Practice Address - Street 1:13111 EAST FWY
Practice Address - Street 2:#108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5820
Practice Address - Country:US
Practice Address - Phone:713-637-8200
Practice Address - Fax:713-637-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G94298Medicare UPIN
TX00574YMedicare PIN