Provider Demographics
NPI:1801929450
Name:I-10 EAR NOSE AND THROAT PA
Entity type:Organization
Organization Name:I-10 EAR NOSE AND THROAT PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANI
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOBRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-455-7555
Mailing Address - Street 1:1140 WESTMONT DR STE 445
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4368
Mailing Address - Country:US
Mailing Address - Phone:713-455-7555
Mailing Address - Fax:713-455-7771
Practice Address - Street 1:1140 WESTMONT DR STE 445
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015
Practice Address - Country:US
Practice Address - Phone:713-455-7555
Practice Address - Fax:713-455-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083125701Medicaid
TX040006005OtherRAIL ROAD MEDICARE
TX83T881OtherBCBS
TX389996OtherWELLCARE
TX083125701Medicaid