Provider Demographics
NPI:1700876976
Name:MISHOE, GARY (LVN, OPAC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MISHOE
Suffix:
Gender:M
Credentials:LVN, OPAC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7401 S. MAIN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4509
Mailing Address - Country:US
Mailing Address - Phone:713-799-2300
Mailing Address - Fax:713-794-3395
Practice Address - Street 1:10333 KUYKENDAHL
Practice Address - Street 2:SUITE D
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382
Practice Address - Country:US
Practice Address - Phone:281-362-7700
Practice Address - Fax:281-367-1323
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2012-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX0000928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant