Provider Demographics
NPI:1487622742
Name:HOUSTON, PAUL N (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:N
Last Name:HOUSTON
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 1:1216 E NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2718
Mailing Address - Country:US
Mailing Address - Phone:812-448-3551
Mailing Address - Fax:812-443-7303
Practice Address - Street 1:1216 E NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2718
Practice Address - Country:US
Practice Address - Phone:812-448-3551
Practice Address - Fax:812-443-7303
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030315A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100079260Medicaid
IN100079260Medicaid
IN091190Medicare PIN
IN080132653Medicare PIN