Provider Demographics
NPI:1306998000
Name:GUREVICH, VLADIMIR (LSA)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:GUREVICH
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 WOODLAND SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6307
Mailing Address - Country:US
Mailing Address - Phone:713-826-1229
Mailing Address - Fax:281-496-3112
Practice Address - Street 1:2106 WOODLAND SPRINGS ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6307
Practice Address - Country:US
Practice Address - Phone:713-826-1229
Practice Address - Fax:281-496-3112
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00040363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty