Provider Demographics
NPI:1861941338
Name:BREAST RECONSTRUCTION CENTERS OF HOUSTON
Entity type:Organization
Organization Name:BREAST RECONSTRUCTION CENTERS OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-742-8187
Mailing Address - Street 1:920 FROSTWOOD DR STE 690
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2468
Mailing Address - Country:US
Mailing Address - Phone:832-742-8187
Mailing Address - Fax:855-926-3963
Practice Address - Street 1:920 FROSTWOOD DR STE 690
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2468
Practice Address - Country:US
Practice Address - Phone:832-742-8187
Practice Address - Fax:855-926-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8534208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty