Provider Demographics
NPI:1427291574
Name:MAXIMOS, BAHER BOUTROS (MD)
Entity type:Individual
Prefix:
First Name:BAHER
Middle Name:BOUTROS
Last Name:MAXIMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130455
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77219-0455
Mailing Address - Country:US
Mailing Address - Phone:716-598-6040
Mailing Address - Fax:
Practice Address - Street 1:810 WAUGH DR
Practice Address - Street 2:STE.200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-2000
Practice Address - Country:US
Practice Address - Phone:716-598-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-18
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN64862086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275962037OtherGROUP TAX ID