Provider Demographics
NPI:1154595569
Name:FORTBEND NEUROLOGY
Entity type:Organization
Organization Name:FORTBEND NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:POPENEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-980-2525
Mailing Address - Street 1:2655 CORDES DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1460
Mailing Address - Country:US
Mailing Address - Phone:281-980-2525
Mailing Address - Fax:281-980-9344
Practice Address - Street 1:2655 CORDES DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1460
Practice Address - Country:US
Practice Address - Phone:281-980-2525
Practice Address - Fax:281-980-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ22592084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136766605Medicaid
TXJ2259OtherTX LICENSE
TXJ2259OtherTX LICENSE
TXF38356Medicare UPIN