Provider Demographics
NPI:1730385402
Name:INTERNAL MEDICINE & GERIATRICS OF HOUSTON, LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE & GERIATRICS OF HOUSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-328-9690
Mailing Address - Street 1:1743 WATSON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3622
Mailing Address - Country:US
Mailing Address - Phone:478-328-9690
Mailing Address - Fax:478-328-9692
Practice Address - Street 1:1743 WATSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3633
Practice Address - Country:US
Practice Address - Phone:478-328-9690
Practice Address - Fax:478-328-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047430207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH08254Medicare UPIN
GAGRP8092Medicare PIN