Provider Demographics
NPI:1174792774
Name:LAUREN SUM
Entity type:Organization
Organization Name:LAUREN SUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-988-4848
Mailing Address - Street 1:3506 HANSFORD PL
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4987
Mailing Address - Country:US
Mailing Address - Phone:832-660-1118
Mailing Address - Fax:281-412-9961
Practice Address - Street 1:9515 BELLAIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4546
Practice Address - Country:US
Practice Address - Phone:713-988-4848
Practice Address - Fax:281-412-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1729213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176307001Medicaid
TX4850990001Medicare NSC
TX176307001Medicaid