Provider Demographics
NPI:1760552590
Name:YOUSEFI, POURAN (MD)
Entity Type:Individual
Prefix:DR
First Name:POURAN
Middle Name:
Last Name:YOUSEFI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 HIGHWAY 6 STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7104
Mailing Address - Country:US
Mailing Address - Phone:713-486-1200
Mailing Address - Fax:281-778-5345
Practice Address - Street 1:8810 HIGHWAY 6 STE 100
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7104
Practice Address - Country:US
Practice Address - Phone:713-486-1200
Practice Address - Fax:281-778-5345
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8078M2Medicare PIN
TX8L0551Medicare PIN
TXH27209Medicare UPIN
TX080164884Medicare PIN