Provider Demographics
NPI:1487733291
Name:DONNA N CANLAS MD PA
Entity type:Organization
Organization Name:DONNA N CANLAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CANLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-526-5588
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:1020
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-526-5588
Mailing Address - Fax:713-526-5599
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:1020
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-526-5588
Practice Address - Fax:713-526-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10030907OtherAMERIGROUP
TX124504507Medicaid
TX=========OtherEVERCARE
TX10030907OtherAMERIGROUP
TX10030907OtherAMERIGROUP