Provider Demographics
NPI:1023291440
Name:WEST HOUSTON OB/GYN ASSOCIATION
Entity type:Organization
Organization Name:WEST HOUSTON OB/GYN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOUTROS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-293-9988
Mailing Address - Street 1:12121 RICHMOND AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2466
Mailing Address - Country:US
Mailing Address - Phone:281-293-9988
Mailing Address - Fax:281-293-8025
Practice Address - Street 1:12121 RICHMOND AVE STE 117
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2466
Practice Address - Country:US
Practice Address - Phone:281-293-9988
Practice Address - Fax:281-293-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7002174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21425Medicare UPIN