Basic Information
| Provider Information | |||||||||
| NPI: | 1710924568 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST HOUSTON MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 JOHN RALSTON RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770135518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136739000 | ||||||||
| FaxNumber: | 7136742493 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 JOHN RALSTON RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770135518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136739000 | ||||||||
| FaxNumber: | 7136742493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 01/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | CRAM | ||||||||
| AuthorizedOfficialFirstName: | LORIE | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7136739000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.