Basic Information
Provider Information | |||||||||
NPI: | 1407855356 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SELZMAN | ||||||||
FirstName: | ANDREW | ||||||||
MiddleName: | ALEX | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 909 FROSTWOOD DR | ||||||||
Address2: | SUITE 1.100 | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770242301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7133384523 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 915 GESSNER RD | ||||||||
Address2: | SUITE 720 | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770242527 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7138309100 | ||||||||
FaxNumber: | 7138309181 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/21/2005 | ||||||||
LastUpdateDate: | 03/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | H8394 | TX | Y |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 8BV063 | 01 | TX | BLUECROSS BLUESHIELD OF TX | OTHER | 83C855 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 042423604 | 05 | TX |   | MEDICAID | P00681394 | 01 | TX | RAILROAD MEDICARE | OTHER | 042423602 | 05 | TX |   | MEDICAID | 042423601 | 05 | TX |   | MEDICAID |