Provider Demographics
NPI:1487975439
Name:BOSSOUS, PAUL-MOREAU (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL-MOREAU
Middle Name:
Last Name:BOSSOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7713
Mailing Address - Country:US
Mailing Address - Phone:956-897-0304
Mailing Address - Fax:
Practice Address - Street 1:1904 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7713
Practice Address - Country:US
Practice Address - Phone:956-897-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT50516207RN0300X
TXP8450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine