Provider Demographics
NPI:1831404755
Name:JOHN J. DEBENDER, M.D., P. A.
Entity type:Organization
Organization Name:JOHN J. DEBENDER, M.D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEBENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-622-5116
Mailing Address - Street 1:4151 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 715
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7312
Mailing Address - Country:US
Mailing Address - Phone:713-622-5116
Mailing Address - Fax:713-622-2684
Practice Address - Street 1:4151 SOUTHWEST FWY
Practice Address - Street 2:SUITE 715
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7312
Practice Address - Country:US
Practice Address - Phone:713-622-5116
Practice Address - Fax:713-622-2684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2217261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00ER39Medicare UPIN
TXB22184Medicare PIN