| Organization Name: | GREATER GULF HEALTH PLAN, LLC |
| NPI Number: | 1457574006 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAWRENCE J WEDEKIND (PRESIDENT) |
| Mailing Address: | 260 N Sam Houston Pkwy E Ste 220 Houston |
| State: | TX US |
| Postal Code: | 770602022 |
| Phone Number: | 2814476800 |
| Fax Number: | 2814476802 |
| NPI Enumeration Date: | 04/11/2007 |
| NPI Last Update Date: | 06/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 01486663 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |