Provider Demographics
NPI:1821300039
Name:JIRALERSPONG, SAO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SAO
Middle Name:
Last Name:JIRALERSPONG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 MAIN ST
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2348
Mailing Address - Country:US
Mailing Address - Phone:713-798-1999
Mailing Address - Fax:713-798-1990
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE 1350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-1999
Practice Address - Fax:713-798-1990
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3595207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB112255Medicare PIN