Provider Demographics
NPI:1942296330
Name:HOUSE, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:HOUSE
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 1:801 W I-20
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5851
Mailing Address - Country:US
Mailing Address - Phone:817-784-8268
Mailing Address - Fax:817-417-1150
Practice Address - Street 1:801 W I-20
Practice Address - Street 2:STE 1
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5851
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-417-1150
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3392208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133718009Medicaid
TX133718004Medicaid
TX133718007Medicaid
TX133718010OtherMEDICAID OTHER
TX133718011Medicaid
TX133718008Medicaid
TX133718009Medicaid
TX133718004Medicaid
TX133718011Medicaid
TX83Z608Medicare PIN