Provider Demographics
NPI:1982895850
Name:AGAN, DUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:AGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 CYPRESS STATION DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3015
Mailing Address - Country:US
Mailing Address - Phone:832-484-1800
Mailing Address - Fax:832-484-1801
Practice Address - Street 1:1125 CYPRESS STATION DR STE 4
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:713-897-7221
Practice Address - Fax:713-897-7235
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062042A207R00000X
TXL6250207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177620502Medicaid
TX177620503Medicaid
TXP00922566OtherMEDICARE RAILROAD
TX8CQ774OtherBCBS
8CW772OtherBCBS TX
TX177620503Medicaid
TXTXB119199Medicare PIN