Provider Demographics
NPI:1841201274
Name:HOUSTON, JOHN TEMPLE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TEMPLE
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 HWY 90 SERVICE ROAD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619
Mailing Address - Country:US
Mailing Address - Phone:251-602-1667
Mailing Address - Fax:251-602-5660
Practice Address - Street 1:2423 SCHILLINGER RD S
Practice Address - Street 2:STE 103
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4136
Practice Address - Country:US
Practice Address - Phone:251-633-5782
Practice Address - Fax:251-633-5364
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76790207Q00000X
IL036095495207Q00000X
AL21707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051542410OtherBLUE CROSS BLUE SHIELD
AL051542410OtherBLUE CROSS BLUE SHIELD