Provider Demographics
NPI:1205876232
Name:VICROY, THERESA G (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:G
Last Name:VICROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1012
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:281-657-0770
Mailing Address - Fax:281-657-1117
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1012
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:281-657-0770
Practice Address - Fax:281-657-1117
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH1713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0800OtherBLUE CROSS
TX8J0800OtherBLUE CROSS
8A8635Medicare ID - Type Unspecified