Provider Demographics
NPI:1871799783
Name:M SANDRA SCURRIA MD PA
Entity type:Organization
Organization Name:M SANDRA SCURRIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:SCURRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-661-5901
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:281-661-5901
Mailing Address - Fax:281-661-5720
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:281-661-5901
Practice Address - Fax:281-661-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB0040736OtherDPS
TXAS9343853OtherDEA
TX00J24NMedicare PIN
TXB0040736OtherDPS