NPI 1144884826

Provisioncare Medical

Organisation Family Medicine Physician Humble, TX

Practice location

Address: 11501 N Sam Houston Pkwy E STE a, Humble, TX 77396-4635
Phone: (281) 652-5612
Fax: (346) 980-4054
Mailing address: 14700 Woodson Park Dr APT 1512, Houston, TX 77044-4531

Authorised official

Name: Derrick Traylor
Title: Ceo
Phone: (503) 901-5733

Registered specialties

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X

Other Family Medicine providers in Texas →

Registry record

NPI: 1144884826
Entity type: Organization
NPI issued: 28 Apr 2019
Record last updated: 11 Jun 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.