Provider Demographics
NPI:1184280695
Name:ODR PEDIATRIC UROLOGY INSTITUTE PLLC
Entity type:Organization
Organization Name:ODR PEDIATRIC UROLOGY INSTITUTE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUNG
Authorized Official - Middle Name:Q
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-366-7831
Mailing Address - Street 1:1200 BINZ ST STE 690
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6943
Mailing Address - Country:US
Mailing Address - Phone:713-366-7931
Mailing Address - Fax:713-482-5815
Practice Address - Street 1:1200 BINZ ST STE 690
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6943
Practice Address - Country:US
Practice Address - Phone:713-366-7931
Practice Address - Fax:713-482-5815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODR PEDIATRIC UROLOGY INSTIUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-10
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty