Provider Demographics
NPI:1669418679
Name:BOGUS, HOUSTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:HOUSTON
Middle Name:
Last Name:BOGUS
Suffix:JR
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 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:972-494-6235
Mailing Address - Fax:972-272-2073
Practice Address - Street 1:601 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5738
Practice Address - Country:US
Practice Address - Phone:972-494-6235
Practice Address - Fax:972-272-2073
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8585207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100014455OtherRR MEDICARE
TX1026338-04Medicaid
TX102633802Medicaid
TX8B9910Medicare PIN
TX8212K2Medicare PIN
TX100014455OtherRR MEDICARE