Provider Demographics
NPI:1215300884
Name:HOUSTON, HUELON
Entity type:Individual
Prefix:
First Name:HUELON
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10631 CORDOBA PINES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-1768
Mailing Address - Country:US
Mailing Address - Phone:601-938-7117
Mailing Address - Fax:281-931-3289
Practice Address - Street 1:10631 CORDOBA PINES DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-1768
Practice Address - Country:US
Practice Address - Phone:601-938-7117
Practice Address - Fax:281-931-3289
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47-1353264347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle