Provider Demographics
NPI:1023093291
Name:SABONGHY, ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SABONGHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:713-486-1700
Mailing Address - Fax:713-467-6682
Practice Address - Street 1:10125 KATY FWY STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1287
Practice Address - Country:US
Practice Address - Phone:713-486-1700
Practice Address - Fax:713-467-6682
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-10
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0558207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AA920OtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TX7857805OtherAETNA
TX613174800OtherDEPARTMENT OF LABOR
TX7857805OtherAETNA
TX613174800OtherDEPARTMENT OF LABOR