Provider Demographics
NPI:1245275718
Name:JENEVIZIAN, ARA (MD)
Entity type:Individual
Prefix:
First Name:ARA
Middle Name:
Last Name:JENEVIZIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARAH
Other - Middle Name:TOROS
Other - Last Name:BOGHOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 S CONROE MEDICAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5341
Mailing Address - Country:US
Mailing Address - Phone:936-304-1166
Mailing Address - Fax:888-464-0852
Practice Address - Street 1:600 S CONROE MEDICAL DR STE 102
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5341
Practice Address - Country:US
Practice Address - Phone:936-304-1166
Practice Address - Fax:888-464-0852
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine