Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 37275 | TX |
Y | 213EG0000X | General Practice | 37275 | TX |
NPI | 1003485418 |
---|---|
Provider Name | Dr. Madison Paige Fuston |
First Address | Houston, TX 77054-2129 |
Second Address | Port Arthur, TX 77642-8039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2021 |
Last Update Date | 21/06/2021 |