1255416855 NPI number — SEAN BOUTROS MD PLLC

Table of content: (NPI 1255416855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255416855 NPI number — SEAN BOUTROS MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEAN BOUTROS MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MY HOUSTON SURGEONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255416855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9230 KATY FWY STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77055-7468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-791-0700
Provider Business Mailing Address Fax Number:
713-791-0703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9230 KATY FWY STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77055-7468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-791-0700
Provider Business Practice Location Address Fax Number:
713-791-0703
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOUTROS
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
713-791-0700

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)