Provider Demographics
NPI:1154344596
Name:CANAL FAMILY AND INDUSTRIAL MEDICINE P.A.
Entity type:Organization
Organization Name:CANAL FAMILY AND INDUSTRIAL MEDICINE P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-223-4466
Mailing Address - Street 1:3003 NAVIGATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-1239
Mailing Address - Country:US
Mailing Address - Phone:713-223-4466
Mailing Address - Fax:713-223-1571
Practice Address - Street 1:3003 NAVIGATION BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1239
Practice Address - Country:US
Practice Address - Phone:713-223-4466
Practice Address - Fax:713-223-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10011602OtherDUARTE AMERIGROUP
TX163266301Medicaid
TX182946701Medicaid
TX163266302Medicaid
TX7948658OtherMONCAYO AETNA
TX8S0531OtherBLUE CROSS MONCAYO
TX182946702Medicaid
TX182946703Medicaid
TX7893532OtherDUARTE AETNA
TX8S0530OtherBLUE CROSS DUARTE
TX182946701Medicaid
TX8S0530OtherBLUE CROSS DUARTE
TX10011602OtherDUARTE AMERIGROUP
TX8S0531OtherBLUE CROSS MONCAYO