Provider Demographics
NPI:1124900071
Name:BURT L FORGASON MD PLLC
Entity type:Organization
Organization Name:BURT L FORGASON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BURT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORGASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-493-0010
Mailing Address - Street 1:14441 MEMORIAL DR STE 6
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6708
Mailing Address - Country:US
Mailing Address - Phone:281-493-0010
Mailing Address - Fax:281-493-3814
Practice Address - Street 1:14441 MEMORIAL DR STE 6
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6708
Practice Address - Country:US
Practice Address - Phone:281-493-0010
Practice Address - Fax:281-493-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty