Provider Demographics
NPI:1124140900
Name:SUGAR LAND MED PED CLINIC, P.A.
Entity type:Organization
Organization Name:SUGAR LAND MED PED CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBODH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHUCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-491-2555
Mailing Address - Street 1:3533 TOWN CENTER BLVD S
Mailing Address - Street 2:# 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1454
Mailing Address - Country:US
Mailing Address - Phone:281-491-2555
Mailing Address - Fax:281-491-2554
Practice Address - Street 1:3533 TOWN CENTER BLVD S
Practice Address - Street 2:# 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1454
Practice Address - Country:US
Practice Address - Phone:281-491-2555
Practice Address - Fax:281-491-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7389208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE57348Medicare UPIN
TX00993NMedicare ID - Type Unspecified