Provider Demographics
NPI:1528052404
Name:FROMMER, JUAN PEDRO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PEDRO
Last Name:FROMMER
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 1:427 W 20TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2429
Mailing Address - Country:US
Mailing Address - Phone:713-791-1633
Mailing Address - Fax:713-791-1710
Practice Address - Street 1:427 W 20TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2429
Practice Address - Country:US
Practice Address - Phone:713-791-1633
Practice Address - Fax:713-791-1710
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2667174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083080401Medicaid
TX81T500Medicare ID - Type UnspecifiedMEDICARE INDIV ID
TX083080401Medicaid