Provider Demographics
NPI:1720315260
Name:PRINCIPLE ANESTHESIA PLLC
Entity Type:Organization
Organization Name:PRINCIPLE ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:TAIGO
Authorized Official - Last Name:FUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-472-4597
Mailing Address - Street 1:PO BOX 57286
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7286
Mailing Address - Country:US
Mailing Address - Phone:281-525-6106
Mailing Address - Fax:832-532-6127
Practice Address - Street 1:5010 CRENSHAW RD
Practice Address - Street 2:SUITE #130
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3047
Practice Address - Country:US
Practice Address - Phone:281-991-2200
Practice Address - Fax:281-991-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A6286Medicare PIN