Provider Demographics
NPI:1790703585
Name:EP DESCANT II MDPA
Entity Type:Organization
Organization Name:EP DESCANT II MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-351-7127
Mailing Address - Street 1:909 GRAHAM DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6473
Mailing Address - Country:US
Mailing Address - Phone:281-351-7127
Mailing Address - Fax:281-255-9140
Practice Address - Street 1:909 GRAHAM DR
Practice Address - Street 2:SUITE D
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6473
Practice Address - Country:US
Practice Address - Phone:281-351-7127
Practice Address - Fax:281-255-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T83KMedicare PIN
00T83KMedicare PIN