Basic Information
| Provider Information | |||||||||
| NPI: | 1023093291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABONGHY | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST STE 1700 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134861700 | ||||||||
| FaxNumber: | 7134676682 | ||||||||
| Practice Location | |||||||||
| Address1: | 10125 KATY FWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134861700 | ||||||||
| FaxNumber: | 7134676682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2005 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | L0558 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8AA920 | 01 | TX | BLUE CROSS AND BLUE SHIELD OF TEXAS | OTHER | 7857805 | 01 | TX | AETNA | OTHER | 613174800 | 01 | TX | DEPARTMENT OF LABOR | OTHER |