Provider Demographics
NPI:1831179241
Name:LONDON GOHEL JOINT VENTURE
Entity type:Organization
Organization Name:LONDON GOHEL JOINT VENTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JOINT VENTURER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-426-4010
Mailing Address - Street 1:1415 NORTH LOOP W STE 240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1677
Mailing Address - Country:US
Mailing Address - Phone:713-426-4010
Mailing Address - Fax:713-426-4015
Practice Address - Street 1:7401 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4509
Practice Address - Country:US
Practice Address - Phone:281-359-7788
Practice Address - Fax:281-359-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165655501Medicaid
TX00080XMedicare PIN
DB8632Medicare PIN