Provider Demographics
NPI:1447249073
Name:ALBUERNE, LUIS M (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:M
Last Name:ALBUERNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2190 NORTH LOOP W
Mailing Address - Street 2:STE 250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8016
Mailing Address - Country:US
Mailing Address - Phone:281-359-7788
Mailing Address - Fax:281-359-7888
Practice Address - Street 1:4401 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2122
Practice Address - Country:US
Practice Address - Phone:281-359-7788
Practice Address - Fax:281-359-7888
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH10362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137742601Medicaid
C57814Medicare UPIN
TX137742601Medicaid
300055959Medicare PIN