Provider Demographics
NPI:1669457826
Name:TUAZON, DIVINA M (MD)
Entity type:Individual
Prefix:DR
First Name:DIVINA
Middle Name:M
Last Name:TUAZON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:SUITE B452
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-3620
Mailing Address - Fax:713-790-2082
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:SUITE B452
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-3620
Practice Address - Fax:713-790-2082
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2013-01-24
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Provider Licenses
StateLicense IDTaxonomies
TXL8218207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181147303Medicaid
TX1669457826OtherBLUE CROSS BLUE SHIELD
TXP01078450OtherRR MEDICARE
LA2319400OtherLA MEDICAID
TXP01078450OtherRR MEDICARE
LA2319400OtherLA MEDICAID
TXH15675Medicare UPIN