Listed by Specialty - Texas Medical Board

Transcription

Physicians Who Agreed to Treat Medicare/Medicaid Patients
Physicians Licensed Between August 2008 - August 2013
Important: This list is updated after each board meeting, which is now five times per year. You should always refer to
the board's profile information for the most recent data and for more details about a physician. The link is below.
You will need the physician's license number for easiest access to profile information.
http://reg.tmb.state.tx.us/OnLineVerif/Phys_NoticeVerif.asp?
This list is sorted alphabetically by primary specialty, then by name.
N4890
AINA, OLUYEMI, MD
2/5/2010
2/5/2015
N6187
N9539
BRADY, KENNETH MARTIN, MD
DEVOE, JAMES FRAUSTO, MD
DOSADO, JOSE MARIUS DEDEL,
MD
6/4/2010
5/2/2011
6/4/2015
5/2/2016
Registration
Status of
Secondary Specialty
Practice
Texas
(Self-Designated)
Practice City
State
License
LICENSE
ISSUED
PEDIATRIC CRITICAL
LICENSE
CARE MEDICINE
ISSUED
PAIN MANAGEMENT WEST PLAINS MO
ACTIVE
8/2/2010
8/2/2015
SIOUX FALLS
MEMON, REHAN, MD
MOHAMED, MAHMOUD
ABDELMONEM, MD
4/1/2013
4/1/2018
4/9/2010
4/9/2015
8/21/2009
8/21/2014
8/26/2011
8/26/2016
License
Number
N7250
P6037
N5875
N3913
Physician Name
N9928
MUKAMANA, GRACE, MD
MURALIDHARA, KESTURKOPPAL ,
MD
NAINA, HARRIS VEZHAPPILLY
KUNJALI, MD
NELSON, DAVID BRYAN, MD
OLOBATUYI, KENISHA DANSEY,
MD
N5975
N4059
N7972
ROBERTS, STEPHEN JAN, MD
SALIB, MICHAEL FAWZY, MD
SUN, DONGXU , MD
P0857
N7643
N9923
Medicare/M Medicare/M
edicaid
edicaid
Agreement Agreement Primary Specialty (SelfStart Date
End Date
Designated)
9/1/2010
6/3/2011
9/1/2015
6/3/2016
6/3/2011
6/3/2016
4/9/2010
4/9/2015
8/21/2009
8/21/2014
10/15/2010 10/15/2015
CLINICAL
NEUROPHYSIOLOGY LAREDO
HEMATOLOGY INTERNAL MEDICINE DALLAS
GYNECOLOGY
DALLAS
GYNECOLOGY
ORTHOPEDIC
SURGERY
Page 1 of 301
LUBBOCK
EL PASO
DALLAS
SD
TX
TX
TX
TX
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
6/4/2010 None
5/9/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/23/2010 None
N/A
4/1/2013 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/21/2009 None
N/A
8/26/2011 None
N/A
ACTIVE
ACTIVE
9/16/2010 None
6/14/2011 None
N/A
N/A
ACTIVE
6/13/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
4/19/2010 None
8/27/2009 None
10/20/2010 None
N/A
N/A
N/A
License
Number
Physician Name
N3361
TYNDALL, MIRIAM LEAH, MD
P3679
P2083
WANG, LEI, MD
edicaid
edicaid
Agreement Agreement Primary Specialty (Self- Secondary Specialty
Start Date
End Date
Designated)
(Self-Designated)
5/29/2009
5/29/2014
GYNECOLOGY
6/15/2012
P4894
WILLIAMS, DANNIE ERICA, MD
MORANI, AJAYKUMAR
CHANDRALAL, MD
P2792
SUNNAPWAR, ABHIJIT , MD
N5748
JOHNSON, DARYHL LINDSAY II, MD
4/9/2010
N5356
REESE, JEFFREY C, MD
2/5/2010
N6680
STANLEY, GREGORY ALAN, MD
6/4/2010
N4056
SAFEEK, YISRAEL MORDECAI, MD
8/21/2009
P6469
5/1/2013
N1023
MONGE, MARIA CLAIRE, MD
NUR, MARCELA MARIA DEL PILAR,
MD
8/29/2008
N7874
SHAH, RONAK VINOD, DO
10/1/2010
P0538
ANWAR, SANOBER SAJJAD, MD
BAUMGARTNER, EDWARD
WILLIAM JR, MD
8/1/2011
10/10/2008
P1628
CALHOUN, WILLIAM JAMES, MD
CHRISTODOULOU,
CHRISTODOULOS , MD
N3582
COX, RONALD LEE , MD
8/21/2009
P0726
8/15/2011
N6941
GRAHAM, BELINDA, MD
HETHERINGTON, KELLY ALICIA,
MD
NARAYAN, ARCHANA RAMANATH,
MD
P1793
NGUYEN, DOANH, MD
P7067
N1274
N2565
2/1/2012
6/15/2017
2/1/2017
ABDOMINAL
11/15/2012 11/15/2017 RADIOLOGY
ABDOMINAL
4/2/2012
4/2/2017 RADIOLOGY
7/1/2013
12/15/2011
4/3/2009
7/1/2010
1/2/2012
Practice City
IRVING
EMERGENCY
MEDICINE
PEDIATRIC
RADIOLOGY
SURGICAL CRITICAL
4/9/2015 ABDOMINAL SURGERY CARE
TRAUMATIC
2/5/2015 ABDOMINAL SURGERY SURGERY
VASCULAR
6/4/2015 ABDOMINAL SURGERY SURGERY
ADMINISTRATIVE
8/21/2014 MEDICINE
ADOLESCENT
INTERNAL MED 5/1/2018 MEDICINE - IM
PEDS
ADOLESCENT
8/29/2013 MEDICINE - PD
PEDIATRICS
AEROSPACE
10/1/2015 MEDICINE
INTERNAL MEDICINE
VASCULAR
8/1/2016 ALLERGY
SURGERY
ANESTHESIOLOGY 7/1/2018 ALLERGY
PAIN MANAGEMENT
ALLERGY AND
PULMONARY
10/10/2013 IMMUNOLOGY
DISEASES
ALLERGY AND
ALLERGY AND
ALLERGY AND
ALLERGY AND
4/3/2014 IMMUNOLOGY
ALLERGY AND
7/1/2015 IMMUNOLOGY
PEDIATRICS
ALLERGY AND
1/2/2017 IMMUNOLOGY
INTERNAL MEDICINE
Page 2 of 301
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
6/12/2009 None
N/A
6/15/2012 None
N/A
2/1/2012 None
N/A
TX
ACTIVE
12/3/2012 None
N/A
SAN ANTONIO TX
ACTIVE
4/4/2012 None
N/A
4/15/2010 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LUBBOCK
TX
ACTIVE
9/1/2009 None
N/A
BOSTON
MA
ACTIVE
6/4/2013 None
N/A
MIDLAND
TX
ACTIVE
9/10/2008 None
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
10/11/2010 None
N/A
8/1/2011 None
N/A
HOUSTON
TX
ACTIVE
7/12/2013 None
N/A
GALVESTON
TX
ACTIVE
10/29/2008 None
N/A
NICOSIA
AL
ACTIVE
3/1/2012 None
N/A
ROCKDALE
TX
ACTIVE
9/14/2009 None
N/A
PLANO
TX
ACTIVE
8/18/2011 None
N/A
CEDAR PARK
TX
ACTIVE
4/27/2009 None
N/A
ACTIVE
7/13/2010 None
N/A
ACTIVE
2/1/2012 None
N/A
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
ALLERGY AND
N7470
OSTROUKHOVA, MARINA, MD
8/16/2010
INTERNAL MEDICINE
ALLERGY AND
P5447
PATTANAIK, DEBENDRA NATH, MD
2/1/2013
2/1/2018 IMMUNOLOGY
RHEUMATOLOGY
RAMIREZ, DANIEL ALBERTO JR,
ALLERGY AND
N5960
MD
4/9/2010
4/9/2015 IMMUNOLOGY
J7150
RAVIPATI, MAHIPAL, MD
CE00003 SLADE, HERBERT BRYAN, MD
6/4/2010
2/4/2011
N4167
TRAN, DAT QUOC, MD
8/21/2009
P7598
ZHAO, WEI, MD
P5266
CLARK, BRADLY DOUGLAS, MD
1/15/2013
P7627
COSSEY, LARRY NICHOLAS, MD
8/15/2013
J4768
DE LA ROZA, GUSTAVO LUIS, MD
7/1/2010
P3322
FOO, WAI CHIN , MD
6/1/2012
P7278
GWIN, KATJA, MD
7/15/2013
P6211
LIU, LINA, MD
4/12/2013
P4720
TORREALBA, JOSE RAMON, MD
P1022
SHAKER, ADEL, MD
9/15/2011
P6944
AMBRUZS, JOSEPHINE MARIE, MD
6/14/2013
N5554
BAO, JIANXIONG RICHARD, MD
4/9/2010
P7614
BURLINGAME, ONAME ORO, MD
8/15/2013
P1282
CHEEMA, SIDRA SHAFIQ, MD
11/4/2011
8/1/2013
10/15/2012
ALLERGY AND
6/4/2015 IMMUNOLOGY
ALLERGY AND
2/4/2016 IMMUNOLOGY
ALLERGY AND
ALLERGY AND
8/1/2018 IMMUNOLOGY
ANATOMIC
1/15/2018 PATHOLOGY
ANATOMIC
8/15/2018 PATHOLOGY
ANATOMIC
7/1/2015 PATHOLOGY
ANATOMIC
6/1/2017 PATHOLOGY
ANATOMIC
7/15/2018 PATHOLOGY
ANATOMIC
4/12/2018 PATHOLOGY
ANATOMIC
10/15/2017 PATHOLOGY
ANATOMIC
PATHOLOGY & LAB
9/15/2016 MEDICINE
ANATOMIC/CLINICAL
6/14/2018 PATHOLOGY
ANATOMIC/CLINICAL
4/9/2015 PATHOLOGY
ANATOMIC/CLINICAL
8/15/2018 PATHOLOGY
ANATOMIC/CLINICAL
11/4/2016 PATHOLOGY
Practice City
EVANSVILLE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TEXAS
LICENSE
IN
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/16/2010 None
N/A
2/1/2013 None
N/A
4/9/2010 None
N/A
6/4/2010 None
N/A
PEDIATRICS
PEDIATRICS,
ALLERGY &
IMMUNOLOGY
FORT WORTH TX
ACTIVE
2/14/2011 None
N/A
HOUSTON
TX
ACTIVE
9/1/2009 None
N/A
PEDIATRICS
RICHMOND
VA
ACTIVE
9/9/2013 None
N/A
CYTOPATHOLOGY
MEMPHIS
TN
ACTIVE
1/22/2013 None
N/A
LITTLE ROCK
AR
ACTIVE
8/21/2013 None
N/A
SYRACUSE
NY
ACTIVE
7/16/2010 None
N/A
HOUSTON
TX
ACTIVE
6/7/2012 None
N/A
DALLAS
TX
ACTIVE
7/19/2013 None
N/A
CYTOPATHOLOGY
TEMPLE
ANATOMIC/CLINICAL
PATHOLOGY
DALLAS
TX
ACTIVE
4/19/2013 None
N/A
TX
ACTIVE
10/18/2012 None
N/A
JACKSON
MS
ACTIVE
9/20/2011 None
N/A
LITTLE ROCK
AR
ACTIVE
7/9/2013 None
N/A
TEMPE
AZ
ACTIVE
4/27/2010 None
N/A
BRENTWOOD TN
ACTIVE
8/26/2013 None
N/A
ACTIVE
11/10/2011 None
N/A
CYTOPATHOLOGY
SELECTIVE
PATHOLOGY
FORENSIC
PATHOLOGY
CYTOPATHOLOGY
Page 3 of 301
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
ANATOMIC/CLINICAL
12/1/2010
12/1/2015 PATHOLOGY
ANATOMIC/CLINICAL
9/17/2012
9/17/2017 PATHOLOGY
ANATOMIC/CLINICAL
10/1/2012
10/1/2017 PATHOLOGY
ANATOMIC/CLINICAL
1/17/2012
1/17/2017 PATHOLOGY
ANATOMIC/CLINICAL
10/1/2012
10/1/2017 PATHOLOGY
ANATOMIC/CLINICAL
8/1/2011
8/1/2016 PATHOLOGY
N8181
DAVIS, WILLIAM GRANT, MD
P4437
DOLZ, MARK STEPHEN, DO
G9735
DUNPHY, CHERIE HILBORN, MD
G4232
HOROWITZ, SUSAN AMY, MD
P4586
KRATZ, KURT GREGORY, MD
P0622
LEE, KEAGAN HYUN-CHUL, MD
N2656
MELTON, SHELBY DEAN, MD
4/3/2009
P2039
MOORE, JULENE RAE, MD
2/1/2012
P3065
RENGO, RENA BURLINGAME, MD
P4718
SMITH, ROBERT STEPHEN, MD
N5409
SMITH, STACEY LANELL, MD
WASHINGTON, ANTOINE PHASHA,
MD
2/5/2010
ZHANG, HAIYING , MD
ABDEL-HALIM, AYMAN MOHAMED
MAMDOUH, MD
ADEYEFA, OLUDAYO ADEDOTUN,
MD
3/1/2013
ANATOMIC/CLINICAL
4/3/2014 PATHOLOGY
ANATOMIC/CLINICAL
2/1/2017 PATHOLOGY
ANATOMIC/CLINICAL
10/1/2017 PATHOLOGY
ANATOMIC/CLINICAL
5/29/2014 PATHOLOGY
ANATOMIC/CLINICAL
10/1/2015 PATHOLOGY
ANATOMIC/CLINICAL
5/1/2017 PATHOLOGY
ANATOMIC/CLINICAL
10/15/2017 PATHOLOGY
ANATOMIC/CLINICAL
2/5/2015 PATHOLOGY
ANATOMIC/CLINICAL
4/9/2015 PATHOLOGY
ANATOMIC/CLINICAL
3/1/2018 PATHOLOGY
2/5/2010
2/5/2015 ANESTHESIOLOGY
3/1/2013
P4603
NORA, FREDERICK, MD
10/1/2012
N3214
O'REILLY, KATIE CAIRNS, MD
5/29/2009
N7862
RAMALINGAM, PREETHA, MD
10/1/2010
N6093
P5764
N4875
P5583
P7379
P1844
L3554
ALI, RIYAZ MOHAMMED, MD
ALLANKU, SARAT, MD
ALLEMAN, DAVID GEORGE, MD
5/1/2012
10/15/2012
4/9/2010
8/1/2013
1/17/2012
2/6/2009
Secondary Specialty
(Self-Designated)
CYTOPATHOLOGY
HEMATOLOGY
(PATHOLOGY)
CYTOPATHOLOGY
CYTOPATHOLOGY
DERMATOPATHOLO
GY
MOLECULAR
GENETIC
PATHOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TYLER
TX
ACTIVE
1/21/2011 None
N/A
MEMPHIS
TN
ACTIVE
9/27/2012 None
N/A
DURHAM
POMPANO
BEACH
NC
ACTIVE
10/3/2012 None
N/A
FL
ACTIVE
1/25/2012 None
N/A
DENISON
TX
ACTIVE
LICENSE
ISSUED
11/1/2012 None
N/A
8/1/2011 None
N/A
ACTIVE
5/20/2009 None
N/A
RATON
NM
ACTIVE
2/6/2012 None
N/A
HEMATOLOGY
(PATHOLOGY)
DENISON
TX
ACTIVE
10/30/2012 None
N/A
PATHOLOGY
ROUND ROCK TX
ACTIVE
6/12/2009 None
N/A
HOUSTON
ACTIVE
10/14/2010 None
N/A
ACTIVE
5/7/2012 None
N/A
10/19/2012 None
N/A
2/5/2010 None
N/A
4/30/2010 None
N/A
3/4/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
3/12/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
8/12/2013 None
1/23/2012 None
2/20/2009 None
N/A
N/A
N/A
TX
DERMATOPATHOLO
GY
ALPHARETTA
GA
ACTIVE
LICENSE
ISSUED
CYTOPATHOLOGY
TYLER
TX
ACTIVE
CYTOPATHOLOGY
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
PAIN MANAGEMENT
LEONARDTOW
N
MD
INTERNAL MEDICINE
HOUSTON
Page 4 of 301
TX
License
Number
P6770
Physician Name
edicaid
edicaid
End Date
Designated)
N4249
AMBARDEKAR, ADITEE PARAG, MD
ANDERSON, CHRISTINE
MARCELITA, MD
N9341
ANDERSON, JARED DEAN, MD
4/8/2011
P3279
ANTOINE, JILL A, MD
6/1/2012
P3280
ANTONELLI, MICHAEL JAMES, DO
6/1/2012
N1983
ARTIME, CARLOS ALEJANDRO, MD
2/6/2009
N7521
P5326
P1162
ARZILLO, TRACI SHARIN, MD
ASOPA, AMIT, MD
ATALLAH, GEORGE MICHEL, DO
P6945
ATTIA, MINAH F, MD
6/3/2013
11/6/2009
8/27/2010
2/1/2013
10/17/2011 10/17/2016 ANESTHESIOLOGY
6/14/2013
Secondary Specialty
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
ANESTHESIOLOGY PAIN MANAGEMENT
Practice City
Registration
Status of
Practice
Texas
State
License
PHILADELPHIA PA
ACTIVE
AUSTIN
TX
ACTIVE
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
SAINT
PETERSBURG FL
PEDIATRIC ANES
(PEDS)
PAIN MANAGEMENT
PAIN MEDICINE
HOUSTON
TX
LEXINGTON
HOUSTON
KY
TX
N9347
P4416
BADR, AHMED EBRAHIM, MD
BAGGETT, LISA R, MD
4/8/2011
9/17/2012
N4931
N9019
BAKER, MACARTHUR L., MD
BALAN, SUDHA, MD
2/5/2010
3/15/2011
N5547
BALL, TIMOTHY RYAN, MD
4/9/2010
P2588
BARKER, JEFFREY RYAN, MD
4/2/2012
N3489
P5334
N9675
BEARDWOOD, GORDON ALAN, MD
BEHZADI, CHRISTEN FLACK, MD
BELLARD, BOBBY JOSEPH, MD
8/21/2009
2/1/2013
5/16/2011
N2942
BERGBAUER, ROBIN , MD
5/29/2009
P2417
BHANDARI, ANGELINA DEVI, MD
3/15/2012
CRITICAL CARE
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PAIN MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Page 5 of 301
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
6/19/2013 None
11/11/2009 None
SEE
PREVIOUS
4/14/2011 ORDER
Disciplinary
Status Date
N/A
N/A
4/11/2011
6/1/2012 None
N/A
6/5/2012 None
N/A
2/17/2009 None
N/A
8/27/2010 None
2/15/2013 None
10/18/2011 None
N/A
N/A
N/A
6/14/2013 None
N/A
4/14/2011 None
9/20/2012 None
N/A
N/A
2/5/2010 None
3/31/2011 None
N/A
N/A
EL PASO
TEMPLE
TX
TX
OAK LAWN
IL
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TEMPLE
TX
ACTIVE
4/21/2010 None
N/A
HOUSTON
TX
ACTIVE
4/12/2012 None
N/A
AUSTIN
ROCHESTER
HOUSTON
TX
NY
TX
ACTIVE
ACTIVE
ACTIVE
8/26/2009 None
2/6/2013 None
6/7/2011 None
N/A
N/A
N/A
GAINESVILLE
FL
ACTIVE
7/27/2009 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
3/21/2012 None
N/A
License
Number
Physician Name
N2010
BOLAR, SUDHIR NARAYANA, MD
N8169
BOLDT, DAVID WARREN, MD
BOULANGER, KRISTINE SERENA,
P7252
MD
N7684
BOYD, KENDRA NICHOLE, MD
P7076
P1525
BRADWAY, JAMES ARTHUR II, MD
BRENNER, JOHN RUSSELL, DO
N9818
N6192
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
2/6/2009
ANESTHESIOLOGY
12/1/2010
CARDIOTHORACIC
7/15/2013
ANESTHESIOLOGY
9/15/2010
7/1/2013
12/1/2011
BRODSKY, HARRIS ELLIOT, MD
6/3/2011
6/4/2010
N8380
BROWN, ANTHONY LAMARR, MD
BROWN, CHRISTOPHER JAMES,
MD
1/3/2011
N6196
P2963
P0177
N1568
BRYANT, JAMES DUKE, DO
BUNKER, SCOTT RYAN, DO
BURROW, TREY CULLEN, MD
BURTON, RUSSELL KEITH, MD
P2833
CAMPBELL, NEVILLE FITZROY, MD
N8894
6/4/2010
6/4/2015
5/1/2012
5/1/2017
7/1/2011
7/1/2016
12/12/2008 12/12/2013
CARGILE, JOHN CORDELL, MD
3/1/2011
N6208
CARTER, AARON MICHAEL, MD
6/4/2010
N4978
CASSADY, CHARLES PATRICK, MD
2/5/2010
P5046
CATTANO, DAVIDE , MD
12/17/2012 12/17/2017 ANESTHESIOLOGY
P5046
12/17/2012 12/17/2017 ANESTHESIOLOGY
P5046
12/17/2012 12/17/2017 ANESTHESIOLOGY
N9825
CAVANAUGH, MARK R, MD
N7995
CELIS, BROOKE BAKER, MD
N7239
P1171
CHAHAL, MANISHA KAUR, MD
CHAKKALAKAL, ANNETTE
ELIZABETH JAMES, MD
6/3/2011
HOUSTON
ARLINGTON
CRITICAL CARE
ANESTHESIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
10/29/2010 10/29/2015 ANESTHESIOLOGY
8/2/2010
PLANO
HOUSTON
TX
TX
SAN ANTONIO TX
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
4/13/2012
Registration
Status of
Practice
Texas
Practice City
State
License
FORT WORTH TX
ACTIVE
DALLAS
TX
ACTIVE
10/17/2011 10/17/2016 ANESTHESIOLOGY
Page 6 of 301
TEMPLE
TX
TX
TX
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
2/25/2009 None
N/A
12/6/2010 None
N/A
7/22/2013 None
9/20/2010 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/8/2013 None
12/13/2011 None
N/A
N/A
6/3/2011 None
N/A
6/4/2010 None
N/A
1/3/2011 None
N/A
6/4/2010
5/3/2012
8/25/2011
1/30/2009
None
None
None
None
N/A
N/A
N/A
N/A
4/13/2012 None
N/A
3/18/2011 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
SHERMAN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
12/20/2012 None
N/A
HOUSTON
TX
ACTIVE
12/20/2012 None
N/A
HOUSTON
TX
12/20/2012 None
N/A
HOUSTON
TX
6/3/2011 None
N/A
GALVESTON
tx
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/29/2010 None
N/A
NEW YORK
NY
ACTIVE
9/9/2010 None
N/A
DENVER
CO
ACTIVE
11/21/2011 None
N/A
License
Number
Physician Name
P7749
CHANG, ALEX CHIA, MD
N0689
CHAU, CHUONG JOHN, MD
AM00023 CHAUDHRY, HAROON W, MD
P7413
CHIRALA, KARTHIK , MD
edicaid
edicaid
End Date
Designated)
8/30/2013
8/29/2008
10/1/2012
8/1/2013
N9830
N5631
N9530
CHO, MICHAEL, MD
CLANTON, DAVID BYRON, MD
COHEN, JOSHUA B, MD
6/3/2011
4/9/2010
5/2/2011
N4992
P0898
P4433
COLLIER, JOHN TOM JR, MD
CRAIG, JOHN ANTHONY, MD
CROTTY, KEVIN PATRICK, DO
2/5/2010
9/1/2011
9/17/2012
N4370
DAS, SUBHASH CHANDRA, MD
11/6/2009
N8903
DAVENPORT, DANIEL FLOYD, MD
3/1/2011
P6154
P6371
P2432
DAVIDSON, JOSEPH LELAND, MD
DE SILVA, ANIL MOHAN, MD
DESAI, RONAK KIRTI, MD
4/12/2013
5/1/2013
3/15/2012
P1290
N9040
N5651
DIAZ, LINA BOLANOS, MD
DIAZ, PAUL MICHAEL, MD
DICKSON, WESLEY ALLAN, MD
N6857
N8090
DILLON, JEFFREY DAVID, MD
DRAGHINAS, DAVID, MD
11/4/2011
3/15/2011
4/9/2010
Secondary Specialty
(Self-Designated)
DRAWERT, CASEY MITCHELL, MD
4/3/2009
N6269
DRENNAN, EMILY LORRAINE, MD
6/4/2010
P5356
2/1/2013
L7362
N3017
DUBOIS, JEFFERY COLEMAN, MD
DUMITRASCU, GEORGE
ALEXANDRU, MD
DYKOSKI, LAURIE NIX, MD
P4754
EAGLETON, KWAME , MD
TX
SAN ANTONIO TX
HOUSTON
TX
SAN ANTONIO TX
FORT HOOD
TX
LACKLAND
AFB
CRITICAL CARE
ANESTHESIOLOGY
PALLIATIVE
MEDICINE
Page 7 of 301
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
10/3/2012 None
8/5/2013 None
N/A
N/A
6/3/2011 None
4/29/2010 None
6/3/2011 None
N/A
N/A
N/A
2/5/2010 None
9/6/2011 None
9/25/2012 None
N/A
N/A
N/A
11/6/2009 None
N/A
ACTIVE
3/7/2011 None
N/A
SAN ANTONIO TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
4/15/2013 None
5/6/2013 None
3/26/2012 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
11/23/2011 None
3/18/2011 None
4/26/2010 None
N/A
N/A
N/A
7/1/2010 None
12/7/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/8/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
2/7/2013 None
N/A
12/4/2012 None
6/9/2009 None
N/A
N/A
11/1/2012 None
N/A
DALLAS
TX
DALLAS
TX
SAN ANTONIO TX
BIRMINGHAM
OTTAWA,
ONTARIO
HOUSTON
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
9/9/2013 None
N/A
9/25/2008 None
N/A
TX
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
11/30/2012 11/30/2017 ANESTHESIOLOGY
5/29/2009
11/1/2012
HOUSTON
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
7/1/2010
11/15/2010 11/15/2015 ANESTHESIOLOGY
N2474
Practice City
HOUSTON
WESLACO
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
AL
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P5357
EDSON, EMMANUEL, MD
2/1/2013
N6279
ELIKAN, LAWRENCE , MD
6/4/2010
J1985
ELLSTROM, STEVEN JORDAN, MD
6/3/2013
P1748
P1992
ENG, DAVID ROBERT, MD
ENG, KRISTINA MARIE-MARTEL,
MD
N8506
N8291
ENGLE, MITCHELL PHILIP, MD
ENGLISH, DUSTIN LEE, MD
P0203
N8393
EPPS, WILLIAM JAMES, MD
ESCOBAR, ENRIQUE DIEGO, MD
7/1/2011
1/3/2011
N5671
ESTRADA, CHRISTOPHER RAY, MD
4/9/2010
P2641
EVERT, LISA MARIE, MD
4/2/2012
N9206
N8003
EWIDA, ASHRAFE, MD
FARAG, ASHRAF NABIL, MD
FEDARAU, MAKSIM
ALEKSANDROVICH, MD
FERNANDEZ-GRELA, MARIO JUAN,
MD
P6813
N8095
N6301
N3654
1/2/2012
2/1/2012
1/18/2011
12/15/2010 12/15/2015 ANESTHESIOLOGY
Secondary Specialty
(Self-Designated)
BROOKLYN
CARDIOTHORACIC
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
SAN ANTONIO TX
BIRMINGHAM
AL
DALLAS
TX
HOUSTON
TX
PEDIATRIC ANES
(PEDS)
CRITICAL CARE
ANESTHESIOLOGY
PHILADELPHIA PA
BROOKLYN
NY
11/15/2010 11/15/2015 ANESTHESIOLOGY
6/4/2010
8/21/2009
NY
PAIN MEDICINE
4/1/2011
10/29/2010 10/29/2015 ANESTHESIOLOGY
6/3/2013
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
N1322
N8916
P1642
FOXX, TRAVIS S, MD
FURBEE, JON MARK, DO
GALLAGHER, MICHAEL PATRICK,
MD
GALLEGOS, PHILLIP , MD
GANO, HEATHER MARIE, MD
N9859
GAREWAL, ARVIND SINGH, MD
6/3/2011
P0213
GARRETT, LAURA MEADOWS, MD
7/1/2011
P7767
GAUTAM, ABHINAV, MD
8/30/2013
CARDIOTHORACIC
ANESTHESIOLOGY
10/10/2008 10/10/2013 ANESTHESIOLOGY
3/1/2011
12/15/2011 12/15/2016 ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
N/A
6/4/2010 None
N/A
6/11/2013 None
N/A
1/9/2012 None
N/A
2/1/2012 None
N/A
1/18/2011 None
12/27/2010 None
N/A
N/A
7/1/2011 None
1/10/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
5/3/2010 None
N/A
4/2/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/11/2011 None
11/3/2010 None
N/A
N/A
6/3/2013 None
N/A
12/8/2010 None
N/A
6/4/2010 None
9/3/2009 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
FL
TAVARES
FL
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
DALLAS
DALLAS
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
Page 8 of 301
TX
Disciplinary
Status Date
2/1/2013 None
LEESBURG
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
12/5/2008 None
3/4/2011 None
12/29/2011 None
SEE
PREVIOUS
6/3/2011 ORDER
N/A
N/A
N/A
6/6/2011
8/8/2011 None
N/A
8/30/2013 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N9372
GAUTAM, NISCHAL
KRISHNAMURTHY, MD
P4868
P1868
GHAFOORI, AHMAD FAWAD, MD
GINGRICH, KEVIN, MD
11/15/2012 11/15/2017 ANESTHESIOLOGY
1/17/2012
N8008
P5069
P5069
P5069
N0799
GLADDING, JEFF , MD
GOENTZEL, BRIAN JOHN, MD
GONZALEZ, NARCISO III, MD
10/29/2010
12/17/2012
12/17/2012
12/17/2012
8/29/2008
10/29/2015
12/17/2017
12/17/2017
12/17/2017
8/29/2013
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
N9559
P2003
N5696
P0399
P2005
GRAHAM-CARLSON, AMY DENISE,
MD
GRAY, VON PRESTON, MD
GUMBERT, SAM , MD
HAIDER, HUMA, MD
HAIRR, JOHN, MD
5/2/2011
2/1/2012
4/9/2010
7/15/2011
2/1/2012
5/2/2016
2/1/2017
4/9/2015
7/15/2016
2/1/2017
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
P1182
N4448
N7545
HAN, ANTHONY TAE HYUNG, MD
HANCHER-HODGES, SHANNON B,
MD
P4574
P6632
P2257
P5377
HANSEN, JACOB JOSEPH, DO
HARDAWAY, TIFFANY
ETHEREDGE, MD
HARRIS, BRYAN MARK, MD
HAYES, CHRISTOPHER BARTON,
MD
HAYES, MATTHEW , MD
HEGDE, JAY NARAYAN, MD
HEMMERICH, JASON, MD
N9220
P7462
HENCE, REGINALD DAVID, MD
HERALD, KAITLIN JEAN, DO
P5817
P0066
P6424
N7099
N2106
4/8/2011
10/17/2011 10/17/2016 ANESTHESIOLOGY
11/6/2009
Secondary Specialty
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Practice City
LITTLE ROCK
Registration
Status of
Practice
Texas
State
License
AR
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
N/A
11/15/2012 None
1/26/2012 None
N/A
N/A
10/29/2010
1/2/2013
1/2/2013
1/2/2013
9/9/2008
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
5/12/2011
2/14/2012
5/3/2010
8/8/2011
2/7/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
11/2/2011 None
N/A
11/30/2009 None
N/A
8/27/2010 None
N/A
7/15/2010 None
2/11/2009 None
N/A
N/A
10/8/2012
5/17/2013
3/6/2012
2/21/2013
None
None
None
None
N/A
N/A
N/A
N/A
4/1/2011 None
9/9/2013 None
N/A
N/A
3/20/2013 None
N/A
6/15/2011 None
5/8/2013 None
N/A
N/A
TX
TX
TX
TX
HOUSTON
TX
HOUSTON
INTERNAL MEDICINE HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
EL PASO
8/27/2010
7/15/2010
2/6/2009
DALLAS
TX
10/1/2012
5/15/2013
3/1/2012
2/1/2013
10/1/2017
5/15/2018
3/1/2017
2/1/2018
DALLAS
DALLAS
DALLAS
SAN DIEGO
TX
TX
TX
CA
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
4/1/2011
8/1/2013
HINKLE, CHELSEA ELIZABETH, MD
3/15/2013
HO, DENNIS , DO
HUH, BILLY KEON, MD
6/15/2011
5/1/2013
PAIN MANAGEMENT
Page 9 of 301
HOUSTON
Disciplinary
Status Date
4/15/2011 None
TEMPLE
TEMPLE
TEMPLE
SAN ANTONIO
PAIN MANAGEMENT
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
8/15/2011
6/14/2013
3/15/2013
NORWICH
BEAUMONT
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
CT
ACTIVE
TX
ACTIVE
1/2/2012
GALVESTON
TX
P0735
P6980
P5818
HUNT, LISA MARGUERITE, MD
HUNTER, GRANT, DO
HURLBURT, BRIAN SCOTT, MD
P1768
HUSTAK, ERIK CHRISTOPHER, MD
N1351
HUTCHINS, MICHAEL WAYNE, MD
N5118
IANOV, IGOR, MD
P2680
P4873
P4874
IBRAHIM, ALI DHIA, MD
IDOWU, OLAKUNLE, MD
IDOWU, TECHECIA TAMARA, MD
P1654
ILIEV, DESSISLAVA DIMITROVA,
MD
12/15/2011 12/15/2016 ANESTHESIOLOGY
N8306
ILIEV, PETER BRATOVANOV, MD
12/15/2010 12/15/2015 ANESTHESIOLOGY
P0906
P7286
IMAS, FRANK, MD
IOSELEVICH, VADIM BORISOVICH,
MD
N9716
P4967
P0068
JAHANGIRI, MOHAMAD FARID, MD
JANSEN, RICHARD KEITH, MD
JENSEN, KRYSTAL KAE, MD
P0239
JOSEPH, DAVID OOMMEN, MD
P6983
N9234
10/10/2008 10/10/2013 ANESTHESIOLOGY
2/5/2010
Practice City
SAN ANTONIO TX
4/2/2012
11/15/2012 11/15/2017 ANESTHESIOLOGY
11/15/2012 11/15/2017 ANESTHESIOLOGY
9/1/2011
7/15/2013
INDIANAPOLIS IN
BROOKLYN
NY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
5/16/2011
11/30/2012 11/30/2017 ANESTHESIOLOGY
6/15/2011
7/1/2011
JOUMA, BASHAR N, MD
KABLE, TIMOTHY DAVID, MD
6/14/2013
4/1/2011
P4467
P5540
KARRI, SARASWATHI V, MD
KATCHER, KELLY RENEE, MD
9/17/2012
2/8/2013
N8802
P2472
N7291
KEY, ELAINE , MD
KHALIL, BUSHRA , MD
KHATRI, KINNARI PATEL, MD
KIDAMBI, SHANTANU SRINIVASAN,
MD
2/15/2011
3/15/2012
8/2/2010
P4663
Secondary Specialty
(Self-Designated)
CRITICAL CARE
ANESTHESIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
SLEEPY
HOLLOW
NY
8/15/2011 None
6/17/2013 None
3/27/2013 None
N/A
N/A
N/A
2/24/2012 None
N/A
ACTIVE
LICENSE
ISSUED
11/17/2008 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
4/9/2012 None
11/20/2012 None
11/19/2012 None
N/A
N/A
N/A
1/23/2012 None
N/A
12/15/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
OH
ACTIVE
9/8/2011 None
N/A
HOUSTON
TX
ACTIVE
7/24/2013 None
N/A
AUSTIN
FRISCO
HOUSTON
TX
CO
TX
ACTIVE
ACTIVE
ACTIVE
5/24/2011 None
12/13/2012 None
6/20/2011 None
N/A
N/A
N/A
TEMPLE
TX
ACTIVE
7/6/2011 None
N/A
MAUMEE
DALLAS
OH
TX
ACTIVE
ACTIVE
6/21/2013 None
4/12/2011 None
N/A
N/A
CLEVELAND
ELMHURST
OH
IL
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
9/18/2012 None
2/18/2013 None
N/A
N/A
2/15/2011 None
4/12/2012 None
9/20/2010 None
N/A
N/A
N/A
10/24/2012 None
N/A
PUTNAM
Page 10 of 301
Disciplinary
Status Date
MARYSVILLE
ANESTHESIOLOGY
10/15/2012 10/15/2017 ANESTHESIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
CT
ACTIVE
License
Number
Physician Name
P5398
KIM, SOO HYUN, MD
KLUCSARITS, SHANNON
P7137
ELIZABETH, MD
N6429
N3121
P5200
KNIGHTON, TOURE ALI, MD
KOLLARS, JOSHUA PATRICK , MD
KORNEGAY, CHASE RYAN, MD
edicaid
edicaid
End Date
Designated)
2/1/2013
7/1/2013
6/4/2010
5/29/2009
1/4/2013
P2708
P3370
KOWALCZYK, COURTNEY ANNE,
MD
KRAMADHATI, ROHITHA, MD
4/2/2012
6/1/2012
N6440
KUMARAN, KARTHIC R, MD
6/4/2010
N9381
LACY, TIMOTHY LESTER, MD
P4881
LAI, VICTOR TINFUNG, MD
4/8/2011
CARDIOTHORACIC
ANESTHESIOLOGY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Practice City
GALVESTON
DALLAS
TX
LANDSMAN, IRA SETH, MD
LARSON, ADAM, MD
2/5/2010
8/15/2011
P0079
LAURICH, REBECCA LYNN, MD
6/15/2011
P2477
LEE, BOWLVA MICHAEL, DO
3/15/2012
P1782
N9092
P2031
N0933
1/2/2012
3/15/2011
2/1/2012
8/29/2008
1/2/2017
3/15/2016
2/1/2017
8/29/2013
8/15/2011
P6864
LIU, HENRY, MD
LO, STEVEN W, MD
LOVOI, JOSEPH JASPER JR, MD
LU, LINGEN , MD
MAKOHONIUK, LESLIE WILLIAM,
MD
MANDYAM, SRINAND ANANDAM,
MD
6/3/2013
P1102
MARKAN, SANDEEP, MD
10/3/2011
N9261
MARTIN, KAHLIL JUSTIN, MD
4/1/2011
N5841
MARTINCHECK, DAVID J., MD
4/9/2010
PEDIATRIC ANES
(PEDS)
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
Page 11 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
2/5/2013 None
N/A
ACTIVE
LICENSE
ISSUED
7/17/2013 None
N/A
6/4/2010 None
N/A
SAN ANTONIO TX
TULSA
OK
ACTIVE
ACTIVE
6/12/2009 None
1/9/2013 None
N/A
N/A
DALLAS
LITTLE ROCK
ACTIVE
ACTIVE
LICENSE
ISSUED
4/9/2012 None
6/7/2012 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
4/15/2011 None
N/A
11/15/2012 None
N/A
2/5/2010 None
8/29/2011 None
N/A
N/A
6/15/2011 None
N/A
3/23/2012 None
N/A
HOLYOKE
TX
AR
MA
11/15/2012 11/15/2017 ANESTHESIOLOGY
G6200
P0752
P0758
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
KANSAS CITY MO
SLC
UT
NEW YORK
NY
HOUSTON
TX
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LINCOLN
NE
KILLEEN
MILWAUKEE
1/2/2012
4/4/2011
2/20/2012
10/29/2008
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
8/18/2011 None
N/A
TX
ACTIVE
6/6/2013 None
N/A
WI
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/14/2011 None
N/A
4/1/2011 None
N/A
4/9/2010 None
N/A
License
Number
N5224
Physician Name
MARTIRENA, MARGARITA EMILIA,
MD
edicaid
edicaid
End Date
Designated)
2/5/2010
6/4/2010
Practice City
N6480
MARZOUK, MICHAEL F, MD
N8037
MATCHETT, GENOVEVE, MD
N6483
MATCHETT, GERALD ALBERT, MD
6/4/2010
N0956
N5852
N2647
8/29/2008
4/9/2010
4/3/2009
N8124
MATISOFF, ANDREW JEFFREY, MD
MCCLAIN, CHASE WAGNER, MD
MCEWEN, DOUG RYAN, MD
MCILVAINE, WILLIAM BROWN JR,
MD
N7840
MCVAY, TRAVIS JAMES, MD
N8322
N9266
P6464
MEDRANO-ENGLAND, KARLA , MD
MEHTA, JAIDEEP HEMU, MD
MERRITT, NATHAN HENRY, MD
H1395
N3891
MERWIN, JOHN DAVID II, MD
MILLER, DENNIS WARREN, MD
N9604
MIRCHANDANI, AMIT, MD
N3897
MISHRA, CHANDER SHEKHAR, MD
P1108
N1776
MITCHELL, BAKER ADAMS III, MD
MOADDELI, NEDA , MD
P4485
P2306
9/17/2012
3/1/2012
N5891
MODI, HRISHIKESH , MD
MOON, TIFFANY SUN, MD
MOTOLENICH, PETER MICHAEL
JR, MD
4/9/2010
N8822
P0257
MOUZI, LISA KRISTINE, MD
MUKALEL, JESSEN JAMES, MD
2/15/2011
7/1/2011
N8493
MURRAY, REBECCA LOUISE, MD
1/18/2011
10/29/2010 10/29/2015 ANESTHESIOLOGY
11/15/2010 11/15/2015 ANESTHESIOLOGY
10/1/2010
Secondary Specialty
(Self-Designated)
PEDIATRIC ANES
(PEDS)
PEDIATRIC ANES
(PEDS)
PAIN MANAGEMENT
PEDIATRIC ANES
(PEDS)
PEDIATRIC ANES
(PEDS)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
7/1/2010
8/21/2009
5/2/2011
8/21/2009
10/3/2011
12/12/2008 12/12/2013 ANESTHESIOLOGY
PAIN MANAGEMENT
CARDIOTHORACIC
ANESTHESIOLOGY
URGENT CARE
MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
Page 12 of 301
Disciplinary
Status Date
2/5/2010 None
N/A
6/4/2010 None
N/A
10/29/2010 None
N/A
6/4/2010 None
N/A
AUSTIN
LUBBOCK
ABILENE
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
9/9/2008 None
4/26/2010 None
4/9/2009 None
N/A
N/A
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
12/2/2010 None
N/A
10/1/2010 None
N/A
2/4/2011 None
4/6/2011 None
5/6/2013 None
N/A
N/A
N/A
7/1/2010 None
9/9/2009 None
N/A
N/A
12/15/2010 12/15/2015 ANESTHESIOLOGY
4/1/2011
5/1/2013
Registration
Status Date
Disciplinary
Status of
Texas
License
GALVESTON
HOUSTON
SOUTHLAKE
TX
TX
TX
ST. LOUIS
EL PASO
MO
TX
ACTIVE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
5/10/2011 None
N/A
ARLINGTON
TX
8/28/2009 None
N/A
CHICAGO
IL
ACTIVE
LICENSE
ISSUED
ACTIVE
10/3/2011 None
1/14/2009 None
N/A
N/A
ACTIVE
ACTIVE
9/21/2012 None
3/6/2012 None
N/A
N/A
HOUSTON
TX
DALLAS
TX
YOUNGSTOW
N
OH
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
HOUSTON
TX
ACTIVE
5/3/2010 None
N/A
2/15/2011 None
7/7/2011 None
N/A
N/A
1/21/2011 None
N/A
License
Number
Physician Name
N4607
MYUNG, CHANG RYUL, MD
NEGRON RODRIGUEZ, BRENDALI ,
P3395
MD
L1948
N3208
N3944
P7322
NELSON, JOELY GENE, MD
NGUYEN, DUY HOANG, MD
NGUYEN, HUONG GIANG, MD
edicaid
edicaid
End Date
Designated)
11/6/2009
6/1/2012
2/5/2010
5/29/2009
8/21/2009
P2501
P2327
NOEL, TAMEKA LACHELLE, MD
NUCKOLS, MATTHEW CHARLES,
MD
OK, JOHN YOUNG, MD
N5298
ORDYNA, NICHOLAS JOHN, MD
2/5/2010
N6553
6/4/2010
N1408
OSKOUI, GASSEM ZEBARJADI, MD
OSORIO, FEDERICO GUILLERMO,
MD
10/10/2008 10/10/2013 ANESTHESIOLOGY
N1817
P3050
PAL, JEFFREY , MD
PAL, SUNITA , MD
12/12/2008 12/12/2013 ANESTHESIOLOGY
5/1/2012
N9107
P6056
PALACIOS, JORGE MAURICIO, MD
PARK, NAM HOON , MD
3/15/2011
4/1/2013
P0776
PARKER-ACTLIS, TOMASINA Q, MD
8/15/2011
N8832
PATEL, ALPESH ISHVERLAL, MD
2/15/2011
P2754
P4497
P2333
PATEL, RAKHI MAGANLAL, MD
PATEL, SAMIR KAUSHIK, MD
PATEL, SEEMA VINOD, MD
4/2/2012
9/17/2012
3/1/2012
N6572
N3991
PAWELEK, OLGA , MD
PETERS, DARRELL WAYNE , DO
6/4/2010
8/21/2009
P7834
PHAN, AN T, MD
8/30/2013
N8443
PHUNG, TRI MINH, MD
7/15/2013
3/15/2012
3/1/2012
1/3/2011
Secondary Specialty
(Self-Designated)
CARDIOTHORACIC
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
Page 13 of 301
Practice City
HARLINGEN
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
SPRING
TX
DENVER
CO
DALLAS
TX
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
EL PASO
BALTIMORE
TX
MD
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
2/5/2010 None
N/A
6/4/2012 None
N/A
2/5/2010 None
6/4/2009 None
9/23/2009 None
N/A
N/A
N/A
9/9/2013 None
N/A
4/5/2012 None
3/13/2012 None
N/A
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
HOUSTON
STEAMBOAT
SPRINGS
TX
ACTIVE
10/20/2008 None
N/A
CO
ACTIVE
ACTIVE
12/24/2008 None
5/22/2012 None
N/A
N/A
LITTLE ROCK
LACONIA
AR
NH
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
4/12/2011 None
4/8/2013 None
N/A
N/A
8/15/2011 None
N/A
2/15/2011 None
N/A
4/2/2012 None
9/26/2012 None
3/15/2012 None
N/A
N/A
N/A
6/4/2010 None
10/5/2009 None
N/A
N/A
8/30/2013 None
N/A
ACTIVE
1/21/2011 None
N/A
GALVESTON
TX
EL PASO
TX
DALLAS
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P1482
PICKNEY, LUCILLE MARY, MD
P3223
P0653
PIERRE, HAROLD LUCO, MD
PIZZOLA, STEPHAN G, MD
5/15/2012
8/1/2011
N2736
N7652
N4682
PORTER, JOHN WARREN, MD
POWELL, KARLYN, MD
PROU, MITCHELL JUIN, MD
4/3/2009
9/1/2010
11/6/2009
N1089
RAJAGIRIYIL, NANCY CHACKO, DO
8/29/2008
P3661
RAJAN, NIRAJA, MD
6/15/2012
P1394
RANA, BILAL A, DO
11/4/2011
P7551
RATSIU, JOANA MARIA, MD
8/1/2013
P6900
N4696
REQUENEZ, EDWARD, MD
RESES, JOSEPH DAVID, MD
6/3/2013
11/6/2009
N8566
RHETT, ESI MOROWA, MD
1/18/2011
N7745
P5564
RIAD, MAGGY G., MD
ROBERSON, RUSSELL STUART,
MD
P1219
N2761
RODRIGUEZ, AXEL , MD
RODRIGUEZ, CARLOS LUIS, MD
N6624
ROETH, NATHAN ADAM, MD
N9773
ROSENTHAL, DAVID SCOTT, MD
N4051
N1871
P1814
ROYAL, KRISTIN JOYCE , MD
SABIA, MICHAEL, MD
SABRI, SAMMY , MD
Secondary Specialty
(Self-Designated)
SAN ANGELO
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
HOUSTON
HOUSTON
GALVESTON
TX
TX
TX
Practice City
11/15/2011 11/15/2016 ANESTHESIOLOGY
9/15/2010
2/8/2013
CARDIOTHORACIC
ANESTHESIOLOGY
PAIN MANAGEMENT
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
CRITICAL CARE
ANESTHESIOLOGY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
CRITICAL CARE
MEDICINE
CRITICAL CARE
ANESTHESIOLOGY
10/17/2011 10/17/2016 ANESTHESIOLOGY
4/3/2009
6/4/2010
5/16/2011
8/21/2009
12/12/2008 12/12/2013 ANESTHESIOLOGY
1/2/2012
PEDIATRIC ANES
(PEDS)
PAIN MANAGEMENT
Page 14 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/15/2011 None
N/A
5/15/2012 None
8/5/2011 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
4/10/2009 None
9/6/2010 None
11/24/2009 None
N/A
N/A
N/A
ACTIVE
9/5/2008 None
N/A
N/A
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
6/15/2012 None
UNDER
BOARD
12/19/2011 ORDER
GRAPEVINE
TX
ACTIVE
9/9/2013 None
N/A
6/10/2013 None
11/24/2009 None
N/A
N/A
1/18/2011 None
N/A
MCALLEN
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
LICENSE
ISSUED
11/4/2011
LOS ANGELES CA
ACTIVE
9/23/2010 None
N/A
CHAPEL HILL
NC
2/12/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/17/2011 None
4/15/2009 None
N/A
N/A
6/4/2010 None
N/A
5/16/2011 None
N/A
8/26/2009 None
4/29/2009 None
1/9/2012 None
N/A
N/A
N/A
DALLAS
AUSTIN
BIRMINGHAM
TX
TX
AL
ACTIVE
ACTIVE
ACTIVE
License
Number
Physician Name
P1589
SALEEM, USMAN, MD
L1732
SARKAR, DEEPAK RANJAN, MD
P4813
SAVAGE, ADAM MICHAEL, MD
SAWICKI, ANGELINE KATHARINE,
P4509
MD
N8346
SCHIRMER, JEREMY ALLEN, MD
SCHWEGLER, ERIKA HERNANDEZ,
P2358
MD
N2788
SETHI, MANU , MD
P1695
SETIAWAN, CHRISTOPHER TAN,
MD
N9295
P2064
SEWELL, ADAM LEE, MD
SHEIKH, SUFYAN AHMAD, MD
N6018
N4095
P2527
SHEPPARD, SHAINA MONIC, MD
SHETH, MILAN KIRAN , MD
SHORE, BRAD LEON, MD
P0294
SHRIVASTAVA, ANJU , MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
12/1/2011
PAIN MEDICINE
11/15/2010 11/15/2015 ANESTHESIOLOGY
11/1/2012
PAIN MANAGEMENT
9/17/2012
12/15/2010 12/15/2015 ANESTHESIOLOGY
3/1/2012
4/3/2009
TEMPLE
TX
Practice City
12/15/2011 12/15/2016 ANESTHESIOLOGY
4/1/2011
2/1/2012
4/9/2010
8/21/2009
3/15/2012
7/1/2011
6/3/2011
5/15/2013
7/15/2013
1/2/2012
RIPLEY
TEMPLE
Registration
Status of
Practice
Texas
State
License
ACTIVE
WV
ACTIVE
TX
ACTIVE
N9958
P6723
P7352
P1818
SHULL, JAMES HERBERT JR, MD
SIDDIQUE, QAZI ASIF, MD
SINGEETHAM, SARITA D, MD
SIVASANKAR, CHITRA, MD
6/3/2016
5/15/2018
7/15/2018
1/2/2017
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
N9133
N8576
P1494
P1232
SKIDMORE, KIMBERLY LYNN, MD
SNYDER, PHILIP CRAIG, MD
SRESHTA, ERIN GEORDI, MD
SRIDHAR, SRIKANTH , MD
P2537
P5736
STAFFORD, AMY , MD
STAUB, LAURA LEY, MD
3/15/2012
3/1/2013
N4766
STRATTON, MICHAEL OGDEN, DO
11/6/2009
P3249
P3255
SUFFIELD, JILL J, MD
TAN, JENS, MD
5/15/2012
5/15/2012
CARDIOTHORACIC
ANESTHESIOLOGY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PAIN MANAGEMENT
HOUSTON
LOWELL
MA
HOUSTON
TX
CARDIOTHORACIC
CORPUS
ANESTHESIOLOGY
CHRISTI
INTERNAL MEDICINE HARLINGEN
DALLAS
SAYRE
3/15/2011
1/18/2011
11/15/2011 11/15/2016 ANESTHESIOLOGY
10/17/2011 10/17/2016 ANESTHESIOLOGY
TX
9/19/2012 None
2/14/2011 None
N/A
N/A
ACTIVE
4/10/2012 None
N/A
ACTIVE
4/21/2009 None
N/A
1/6/2012 None
N/A
4/1/2011 None
2/7/2012 None
N/A
N/A
4/9/2010 None
10/1/2009 None
4/11/2012 None
N/A
N/A
N/A
7/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
PALMDALE
CA
GALVESTON
HOUSTON
TX
TX
HOUSTON
TX
ST. LOUIS
Page 15 of 301
ACTIVE
ACTIVE
TX
TX
TX
PA
GENERAL PRACTICE SAN ANTONIO TX
MO
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
2/20/2012 None
N/A
1/19/2011 None
N/A
11/6/2012 None
N/A
6/13/2011
5/23/2013
7/17/2013
1/9/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
4/4/2011
1/24/2011
11/22/2011
10/24/2011
None
None
None
None
N/A
N/A
N/A
N/A
3/15/2012 None
3/5/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
11/12/2009 None
N/A
5/15/2012 None
5/17/2012 None
N/A
N/A
License
Number
P3256
Physician Name
TARNAL, VIJAYKUMAR
CHANDRASHEKAR, MD
P5574
TAYLOR, MATTHEW TODD, MD
N9315
N8354
TAYLOR, TRAVIS JAY, MD
TEISSLER, HANA , MD
edicaid
edicaid
End Date
Designated)
5/15/2012
2/8/2013
4/1/2011
12/15/2010 12/15/2015 ANESTHESIOLOGY
P6927
N4794
TELLA, SWATHI NALLURI, MD
THAMMASITHIBOON, SANDY, MD
6/3/2013
11/6/2009
N9142
P6288
THORSON, MATTHEW G, MD
TOBLER, KENNETH SCOTT, MD
3/15/2011
4/12/2013
P2797
TOMAJIAN, SAMIR ABDOU, MD
4/2/2012
N4164
TORRES, JAIME ENRIQUE , MD
TRAMPOTA, SARAH ELIZABETH,
MD
TRAN-NGUYEN, JACKLYN
BICHTHUY, MD
TRINH, TAN N, MD
8/21/2009
N1480
N1482
P6537
P7221
N1931
P7719
TRIVEDI, PREMAL MADHUKAR, MD
TUNSTALL, STANLEY RAY, MD
TURK, CLIFFORD PERCY, MD
N6074
TVERYE, ELLIOT, MD
N4814
UKPEDE, JOHNSON AKPOBA, MD
P1424
P4721
N7507
P1027
P7224
ULLAH, SANA, MD
UNDERWOOD, JOEL RALEY, MD
VAN PRAAG, CINDY A, MD
VANCE, DAVID ALLEN, MD
VANGA, NAVEEN , MD
P3476
VENKATARAMAN, ADITYA, MD
Secondary Specialty
(Self-Designated)
GALVESTON
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
CRITICAL CARE
ANESTHESIOLOGY
EMERGENCY
MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
10/10/2008 10/10/2013 ANESTHESIOLOGY
5/1/2013
4/9/2010
11/6/2009
11/4/2011
10/15/2012 10/15/2017 ANESTHESIOLOGY
8/16/2010
9/15/2011
7/1/2013
6/1/2012
TX
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
CRITICAL CARE
ANESTHESIOLOGY
Page 16 of 301
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/18/2012 None
N/A
2/8/2013 None
N/A
NEWARK
EL PASO
NJ
TX
ACTIVE
ACTIVE
4/6/2011 None
12/21/2010 None
N/A
N/A
DALLAS
DALLAS
TX
TX
6/5/2013 None
11/24/2009 None
N/A
N/A
TEMPLE
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/15/2011 None
4/17/2013 None
N/A
N/A
4/2/2012 None
N/A
10/10/2008 10/10/2013 ANESTHESIOLOGY
7/1/2013
12/12/2008 12/12/2013 ANESTHESIOLOGY
8/15/2013
Practice City
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
ACTIVE
9/3/2009 None
N/A
SAN ANTONIO TX
REDWOOD
CITY
CA
GALVESTON TX
ACTIVE
10/21/2008 None
N/A
ACTIVE
ACTIVE
12/3/2008 None
5/14/2013 None
N/A
N/A
HOUSTON
LONGVIEW
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/9/2013 None
2/9/2009 None
8/20/2013 None
N/A
N/A
N/A
4/9/2010 None
N/A
ACTIVE
11/16/2009 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
11/11/2011
11/20/2012
9/13/2010
9/21/2011
7/8/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
6/1/2012 None
N/A
LITTLE ROCK
TYLER
TUCSON
SAN ANGELO
TX
TX
AR
TX
AZ
TX
License
Number
P6933
N1947
N7020
P0318
N7509
Physician Name
VILLA-ROYVAL, SILVIA MARIANA,
MD
VU, KHANG NGUYEN, MD
WADE, RYAN SCOTT, DO
WARREN, RANDALL JAMES, MD
WEISS, CAREY IRA, MD
P3485
WILCOX, DARRELL WALLACE, MD
P6551
P0518
P3100
WILLIS, THOMAS JOSEPH, MD
WILSON, JUSTIN WESLEY, MD
WIRTH, JOHNNY JAMES, MD
P5497
WOO, JUAN ANTONIO, MD
P7051
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
6/3/2013
12/12/2008 12/12/2013 ANESTHESIOLOGY
7/1/2010
7/1/2011
8/16/2010
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
DALLAS
TX
ACTIVE
TAMPA
FL
ACTIVE
FT. WORTH
TX
ACTIVE
6/1/2012
5/1/2013
7/15/2011
5/1/2012
2/1/2013
WU, KENNETH QIAN, MD
6/14/2013
P5248
YACOB, GABRIEL E, MD
1/4/2013
P3488
YAKER, KENNETH MARCUS, MD
6/1/2012
GENERAL PRACTICE IRVING
N7766
YAMOAH, EDWARD HAMMOND, MD
9/15/2010
N8746
YANG, DIANA PEGGY, MD
2/4/2011
N6114
ANESTHESIOLOGY
N/A
N/A
N/A
N/A
N/A
ACTIVE
6/7/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
5/7/2013 None
8/2/2011 None
5/3/2012 None
N/A
N/A
N/A
ACTIVE
2/19/2013 None
N/A
ACTIVE
LICENSE
ISSUED
6/18/2013 None
N/A
1/4/2013 None
N/A
TX
ACTIVE
6/15/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/20/2010 None
N/A
2/4/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
5/17/2013 None
N/A
2/15/2011 None
N/A
8/5/2011 None
10/20/2010 None
N/A
N/A
4/12/2013 None
7/3/2013 None
N/A
N/A
PEDIATRIC ANES
(PEDS)
6/3/2013
1/1/2009
7/13/2010
7/8/2011
8/19/2010
Disciplinary
Status Date
None
None
None
None
None
HOUSTON
TX
CORPUS
CHRISTI
TX
SAN ANTONIO TX
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
4/9/2010
P6752
YAZDANI, AMIR , MD
YELVERTON, BRYAN CHARLES,
MD
5/15/2013
N8875
YOLLAND, MICHAEL , MD
2/15/2011
P0325
N7894
YOUNGBLOOD, SLOAN CURRY, MD
YU, SAN-SAN, MD
7/1/2011
10/1/2010
HOUSTON
AUSTIN
TX
TX
P6302
P7231
YURATICH, DANE MARIE, MD
ZEHM, CHARLES FLOYD, MD
4/12/2013
7/1/2013
GALVESTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
N2895
P1252
ZELISKO, MICHAEL BLAINE, MD
ZHENG, GANG, MD
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
4/14/2009 None
10/25/2011 None
N/A
N/A
N7605
BHASKARA, SRIDHAR, MD
PEORIA
IL
ACTIVE
10/14/2010 None
N/A
4/3/2009
10/17/2011 10/17/2016 ANESTHESIOLOGY
ANESTHESIOLOGY 9/1/2010
9/1/2015 PAIN MANAGEMENT
SAN ANTONIO TX
PAIN MANAGEMENT
Page 17 of 301
edicaid
edicaid
License
Agreement Agreement Primary Specialty (SelfNumber
Physician Name
Start Date
End Date
Designated)
ANESTHESIOLOGY P7106
ESCORCIA, EDUARDO , MD
7/1/2013
ANESTHESIOLOGY N7259
FOWLER, ROBIN JAMES, MD
8/2/2010
HAHN, GIORA, MD
7/15/2011
HANA, MICHAEL SHEHATA, MD
12/15/2010 12/15/2015 PAIN MANAGEMENT
HAYES, GREGORY PATRICK, MD
11/6/2009
HERLAND, JONATHAN SETH, MD
5/1/2013
HORD, ALLEN HENRY, MD
12/1/2010
IKHISEMOJIE, AUGUSTA UAYE, MD 11/15/2011 11/15/2016 PAIN MANAGEMENT
KULKARNI, ANIRUDHA PRADEEP,
DO
1/18/2011
LEE, KATIE AMY, MD
7/15/2013
LIN, TED TAI KU, MD
4/13/2012
LIU, LI-HERNG, MD
2/10/2012
LOPEZ, RAUL JOSE, MD
7/15/2013
MARTINEZ, MARTE AQUILES JR,
MD
10/29/2010 10/29/2015 PAIN MANAGEMENT
P0997
MCKISSACK, MELANIE LENISE, MD
9/15/2011
N7563
8/27/2010
P4607
MILLER, RHEE WADE, MD
POURALIFAZEL, POOYA PATRICK,
MD
N6976
RODRIGUEZ, GABRIEL ANGEL, MD
7/1/2010
N7869
SANDERS, GEREMY LEE, MD
10/1/2010
N8574
SILBERBERG, ALAN DOUGLAS, MD
1/18/2011
10/1/2012
ANESTHESIOLOGY 9/15/2016 PAIN MANAGEMENT
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ANESTHESIOLOGY
AUSTELL
GA
ACTIVE
8/19/2013 None
N/A
ANESTHESIOLOGY
CONYERS
GA
ACTIVE
9/9/2010 None
N/A
ASPEN
CO
ACTIVE
LICENSE
ISSUED
8/10/2011 None
N/A
12/15/2010 None
N/A
ACTIVE
12/8/2009 None
N/A
ANESTHESIOLOGY
ANESTHESIOLOGY
FAMILY MEDICINE
BANGOR
ME
ACTIVE
5/7/2013 None
N/A
ATLANTA
GRAND
PRAIRIE
GA
ACTIVE
1/14/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
12/5/2011 None
N/A
1/18/2011 None
N/A
DALLAS
TX
ACTIVE
7/23/2013 None
N/A
GALVESTON
TX
ACTIVE
4/20/2012 None
N/A
ACTIVE
2/21/2012 None
N/A
8/7/2013 None
N/A
10/29/2010 None
N/A
ACTIVE
12/6/2011 None
N/A
ACTIVE
9/10/2010 None
N/A
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
EL PASO
GALVESTON
TX
TX
ANESTHESIOLOGY
ANESTHESIOLOGY
OKLAHOMA
CITY
OK
ACTIVE
10/15/2012 None
N/A
IRVING
TX
ACTIVE
7/12/2010 None
N/A
ACTIVE
10/11/2010 None
N/A
ACTIVE
1/24/2011 None
N/A
ANESTHESIOLOGY
ANESTHESIOLOGY
Page 18 of 301
ACTIVE
LICENSE
ISSUED
AUSTIN
TX
License
Number
Physician Name
P0796
SPRINTZ, MICHAEL PHILLIP, DO
P0799
THOMAS, KATHERINE ANNE, MD
P2814
ZAKY SALAMA, WADID, MD
P2230
DOE, ANDREW LAWRENCE, MD
N4692
RECKSON, MARK, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
ANESTHESIOLOGY
ANGIOGRAPHY &
INTERVENTIONAL
DIAGNOSTIC
3/1/2012
3/1/2017 RADIOLOGY
RADIOLOGY
11/6/2009
N8411
KAHN, YOSEF, MD
1/3/2011
P0098
MEHTA, RAJUL RAJNIKANT, MD
6/15/2011
N9674
BANSAL, SHANTI LAL, MD
5/16/2011
H4918
FITZGERALD, DAVID MICHAEL, MD
10/1/2010
N1682
HONG, MAURICIO FEDERICO, MD
12/12/2008
N7106
HSING, JEFF MINDY, MD
7/15/2010
N8201
KARAM, PASCAL Y, MD
12/1/2010
N7628
KOLASA, MARK WAYNE, MD
9/1/2010
P2292
MAKKAR, AKASH, MD
3/1/2012
P7675
MORCOS, HANAN, MD
8/15/2013
11/6/2014 BODY IMAGING
CARDIAC
BRACHYTHERAPY/HY ELECTROPHYSIOLO
1/3/2016 PERTHERMIA
GY
DIAGNOSTIC
6/15/2016 BREAST IMAGING
RADIOLOGY
CARDIAC
ELECTROPHYSIOLOG
5/16/2016 Y
CARDIOLOGY
CARDIAC
ELECTROPHYSIOLOG
10/1/2015 Y
CARDIOLOGY
CARDIAC
ELECTROPHYSIOLOG
12/12/2013 Y
CARDIOLOGY
CARDIAC
ELECTROPHYSIOLOG ELECTROPHYSIOLO
7/15/2015 Y
GY
CARDIAC
ELECTROPHYSIOLOG CARDIOVASCULAR
12/1/2015 Y
DISEASES
CARDIAC
ELECTROPHYSIOLOG
9/1/2015 Y
CARDIOLOGY
CARDIAC
3/1/2017 Y
DISEASES
CARDIAC
8/15/2018 Y
DISEASES
Page 19 of 301
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
ACTIVE
8/22/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/19/2011 None
N/A
4/2/2012 None
N/A
NJ
ACTIVE
3/26/2012 None
N/A
ST
PETERSBURG FL
ACTIVE
11/30/2009 None
N/A
1/3/2011 None
N/A
ACTIVE
6/20/2011 None
N/A
UNION
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
5/19/2011 None
N/A
TEMPLE
TX
ACTIVE
10/19/2010 None
N/A
CLEVELAND
OH
ACTIVE
12/30/2008 None
N/A
HOUSTON
TX
ACTIVE
7/19/2010 None
N/A
ACTIVE
12/21/2010 None
N/A
RANDOLPH
AFB
TX
ACTIVE
9/7/2010 None
N/A
ANN ARBOR
MI
ACTIVE
3/6/2012 None
N/A
SAN ANGELO
TX
ACTIVE
8/19/2013 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
CARDIAC
ELECTROPHYSIOLOG
N5926
OSHODI, GANIYU OLUKAYODE, MD
4/9/2010
4/9/2015 Y
CARDIAC
ELECTROPHYSIOLOG
P2927
SORAJJA, DAN, MD
4/13/2012
4/13/2017 Y
CARDIAC
ELECTROPHYSIOLOG
P0155
YOO, DALE, MD
6/15/2011
6/15/2016 Y
CARDIOJAFFRANI, WASEEM MUHAMMAD,
INTERVENTIONAL
P5086
MD
12/17/2012 12/17/2017 RADIOLOGY
INTERVENTIONAL
P5086
MD
12/17/2012 12/17/2017 RADIOLOGY
INTERVENTIONAL
P5086
MD
12/17/2012 12/17/2017 RADIOLOGY
CARDIOINTERVENTIONAL
L3546
SACHDEVA, RAJESH, MD
8/29/2008
8/29/2013 RADIOLOGY
P6120
AHMED, AGHA JAMIL, MD
4/12/2013
4/12/2018 CARDIOLOGY
P5254
AHMED, SYED MASHOOD, MD
1/15/2013
P4406
9/17/2012
P5321
AHMED, SYED NASIM, MD
ALETI, SUMITH CHANDER REDDY,
MD
2/1/2013
2/1/2018 CARDIOLOGY
P7240
M8509
ALSAAB, SAAD , MD
ASHRITH, GUHA , MD
7/15/2013
5/15/2013
P6329
P4544
ATASHBAND, ARMITA , MD
AYALLOORE, SIBY GEORGE, MD
5/1/2013
10/1/2012
5/1/2018 CARDIOLOGY
P7744
BHAT, PRADEEP KRISHNA, MD
8/30/2013
P6794
CEDRONE, ANTHONY JOSEPH, MD
6/3/2013
6/3/2018 CARDIOLOGY
P4941
CHAWLA, DAVE, MD
Secondary Specialty
(Self-Designated)
CARDIOLOGY
Practice City
WACO
Registration
Status of
Practice
Texas
State
License
TX
CARDIOLOGY
CARDIOVASCULAR
DISEASES
DALLAS
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
4/14/2010 None
N/A
LICENSE
ISSUED
4/13/2012 None
N/A
ACTIVE
6/20/2011 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
12/17/2012 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
12/17/2012 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
12/17/2012 None
N/A
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
CARDIOVASCULAR
IMAGING
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
INTERNAL MEDICINE
LITTLE ROCK
AR
ACTIVE
9/15/2008 None
N/A
WICHITA
KS
ACTIVE
4/23/2013 None
N/A
CARROLL
IA
ACTIVE
2/7/2013 None
N/A
MODESTO
CA
ACTIVE
LICENSE
ISSUED
9/24/2012 None
N/A
2/1/2013 None
N/A
ACTIVE
ACTIVE
7/23/2013 None
7/12/2013 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/3/2013 None
12/3/2012 None
N/A
N/A
8/30/2013 None
N/A
6/3/2013 None
N/A
12/11/2012 None
N/A
TOMBALL
HOUSTON
TX
TX
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
MARBLE
FALLS
11/30/2012 11/30/2017 CARDIOLOGY
Page 20 of 301
TX
ACTIVE
Registration
edicaid
edicaid
Status of
License
Practice
Texas
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
Practice City
State
License
P2615
CHIN, MARK MAW-CHANG, MD
4/2/2012
4/2/2017 CARDIOLOGY
INTERNAL MEDICINE FARMINGTON MO
ACTIVE
LICENSE
P6599
CHOUFANI, JOE NAJI, MD
5/15/2013
INTERNAL MEDICINE
ISSUED
INTERVENTIONAL
LICENSE
N7070
CHOW, PING HOLLAND, MD
7/15/2010
CARDIOLOGY
ISSUED
INTERVENTIONAL
P5788
CIANCI, CHRISTOPHER BRIAN, DO
3/15/2013
CARDIOLOGY
DENTON
TX
ACTIVE
TEXAS
CRITICAL CARE
LICENSE
M9947
DANDAPANTULA, HARI KUMAR, MD
2/8/2013
2/8/2018 CARDIOLOGY
MEDICINE
ISSUED
INTERVENTIONAL
P5794
DESHMUKH, ANAND RAMESH, MD
3/15/2013
CARDIOLOGY
OMAHA
NE
ACTIVE
DEVANEY, RACHEL LEA ISRAEL,
INTERVENTIONAL
LICENSE
P6964
MD
6/14/2013
CARDIOLOGY
TYLER
TX
ISSUED
N9041
DOAN, DENNIS PHUONG, MD
3/15/2011
INTERNAL MEDICINE
ACTIVE
GERIATRIC
MEDICINE (INTERNAL
LICENSE
N8643
DODLA, SARITHA, MD
2/4/2011
2/4/2016 CARDIOLOGY
MED)
ISSUED
PEDIATRIC CRITICAL
N3011
DOROSTKAR, PARVIN C, MD
5/29/2009
CARE MEDICINE
MINNEAPOLIS MN
ACTIVE
N3014
DUBIN, JOSEPH ETHAN, MD
5/29/2009
HOUSTON
TX
ACTIVE
N9544
FARZANEH-FAR, RAMIN, MD
5/2/2011
5/2/2016 CARDIOLOGY
INTERNAL MEDICINE DALLAS
TX
ACTIVE
INTERVENTIONAL
LICENSE
P7636
GEORGE, JOHN MICHAEL, MD
8/15/2013
CARDIOLOGY
ISSUED
P0220
GREENE, NOAH HIMES, MD
7/1/2011
7/1/2016 CARDIOLOGY
NELLIS AFB
NV
ACTIVE
N3699
GUALANO, SARAH KATHRINE , MD
8/21/2009
P6972
GUJJA, KARTHIK REDDY, MD
6/14/2013
INTERVENTIONAL
CARDIOLOGY
N7098
HANNA-MOUSSA, SHAFIK, MD
7/15/2010
INTERNAL MEDICINE
N5707
4/9/2010
4/9/2015 CARDIOLOGY
N3074
N1674
HARDAWAY, BRIAN WILLIAM, MD
HASSAN, WALID SAYED
MOHAMED, MD
HAWKINS, KARIN NATHALIE, MD
N6379
ISSAC, TIM THOMAS, MD
N9578
KIM, JAMES YOUNG, MD
5/29/2009
12/12/2008 12/12/2013 CARDIOLOGY
6/4/2010
5/2/2011
TX
CARDIOVASCULAR
DISEASES
INTERNAL MEDICINE SAN ANTONIO TX
6/4/2015 CARDIOLOGY
5/2/2016 CARDIOLOGY
TX
INTERVENTIONAL
CARDIOLOGY
Page 21 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
4/11/2012 None
N/A
5/15/2013 None
N/A
7/15/2010 None
N/A
3/20/2013 None
N/A
2/8/2013 None
N/A
3/20/2013 None
N/A
6/14/2013 None
3/28/2011 None
N/A
N/A
2/4/2011 None
N/A
6/17/2009 None
6/3/2009 None
6/15/2011 None
N/A
N/A
N/A
8/15/2013 None
7/8/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/4/2009 None
N/A
6/14/2013 None
N/A
7/15/2010 None
N/A
ACTIVE
4/19/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/6/2009 None
1/7/2009 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
5/9/2011 None
N/A
License
Number
edicaid
edicaid
End Date
Designated)
Registration
Status of
Practice
Texas
State
License
N7296
KRAUSE, STEVEN WILLIAM, DO
8/2/2010
8/2/2015 CARDIOLOGY
N7126
KUNJUMMEN, BINU JAMES, MD
7/15/2010
P7149
7/1/2013
7/1/2018 CARDIOLOGY
N8950
LINDLE, KATHERINE ALEXIS, MD
MARMOL-VELEZ, JUAN
ALEJANDRO, MD
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
PEDIATRICS,
CARDIOLOGY
3/1/2011
3/1/2016 CARDIOLOGY
P0091
MARTINEZ, JUAN DIEGO, MD
6/15/2011
N3870
8/21/2009
N9099
MARTINI, WISAM , MD
MOGABGAB, OWEN NORTHROP,
MD
3/15/2011
P2309
MOTTL, STEVEN DAVID JR, DO
3/1/2012
3/1/2017 CARDIOLOGY
P2312
MURTY, RAMANA M, MD
3/1/2012
3/1/2017 CARDIOLOGY
N9474
N7467
NACHIMUTHU, SENTHIL, MD
NAM, YOUNG-JAE , MD
4/15/2011
8/16/2010
N5279
N9924
NATHAN, SRIRAM S, MD
NIRAJ, ASHUTOSH, MD
2/5/2010
6/3/2011
2/5/2015 CARDIOLOGY
6/3/2016 CARDIOLOGY
INTERNAL MEDICINE DETROIT
P6481
OBERTON, SELBY BRENT, MD
5/1/2013
5/1/2018 CARDIOLOGY
INTERNAL MEDICINE
N8053
N3406
P7188
10/29/2010 10/29/2015 CARDIOLOGY
5/29/2009
7/1/2013
7/1/2018 CARDIOLOGY
INTERNAL MEDICINE
P7694
OSORIO, HECTOR JAIRO, MD
PACKER, MILTON , MD
RABDIYA, VIMAL, MD
RAO, KRISHNASREE KASUGANTI,
MD
L7871
P4809
P0290
Physician Name
8/15/2013
SAHETA, SANJAYA NARAYAN, MD
SALIFU, ZAKARE, DO
SANGHAVI, MONIKA, MD
1/4/2013
11/1/2012
7/1/2011
1/4/2018 CARDIOLOGY
7/1/2016 CARDIOLOGY
P6718
SARKAR, KUNAL, MD
5/15/2013
N7871
SAYEED, JAWEED, MD
10/1/2010
Practice City
QUINCY
HOUSTON
IL
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
8/5/2010 None
N/A
7/15/2010 None
N/A
ACTIVE
7/12/2013 None
N/A
3/16/2011 None
N/A
6/15/2011 None
N/A
INTERNAL MEDICINE GALVESTON
INTERVENTIONAL
CARDIOLOGY
LANCASTER
TX
ACTIVE
LICENSE
ISSUED
OH
ACTIVE
9/4/2009 None
N/A
INTERNAL MEDICINE
CARDIOVASCULAR
IMAGING
INTERVENTIONAL
CARDIOLOGY
TX
ACTIVE
3/29/2011 None
N/A
LEWISVILLE
TX
STEUBENVILL
E
OH
ACTIVE
3/12/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
ACTIVE
ACTIVE
3/15/2012 None
N/A
4/15/2011 None
9/16/2010 None
N/A
N/A
2/5/2010 None
6/10/2011 None
N/A
N/A
5/1/2013 None
N/A
10/29/2010 None
6/18/2009 None
9/2/2013 None
N/A
N/A
N/A
8/15/2013 None
N/A
1/4/2013 None
11/7/2012 None
7/18/2011 None
N/A
N/A
N/A
ACTIVE
5/16/2013 None
N/A
ACTIVE
10/11/2010 None
N/A
DALLAS
INTERNAL MEDICINE
DALLAS
INTERNAL MEDICINE URBABA
TX
MI
IL
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
Page 22 of 301
WASHINGTON PA
GLASGOW
KY
DALLAS
TX
AURORA
IL
License
Number
P0876
N8148
Physician Name
SHAQRA, HUSSEIN ABDO, MD
SIVAPRAKASAPILLAI, BRAHMESH,
MD
edicaid
edicaid
End Date
Designated)
8/26/2011
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
CARDIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
11/15/2010 11/15/2015 CARDIOLOGY
P4515
STONE, KENNETH ERIC, MD
9/17/2012
N6695
K6350
6/4/2010
6/4/2015 CARDIOLOGY
12/15/2011 12/15/2016 CARDIOLOGY
N6713
SULLIVAN, CLYDE II, MD
SUMMERS, JOHN HOWARD, MD
THIBODEAU, JENNIFER TAYLOR,
MD
N6715
N8068
THOMPSON, ELISSA COOKE, MD
TONG, CARL WEI-CHAN, MD
6/4/2010
6/4/2015 CARDIOLOGY
10/29/2010 10/29/2015 CARDIOLOGY
N9978
P0940
WALES, ROBERT ALAN, MD
WANG, HAOJIE , MD
P5145
P5145
P5145
WATTS, JAMES , MD
WATTS, JAMES , MD
WATTS, JAMES , MD
N5491
N9425
P4840
WU, JUSTINA CHIA-SU , MD
YELAMANCHILI, PRIDHVI
RAJAKUMAR, MD
ZHOU, LI, MD
P4950
FOX, LINDSAY ARNOULT, MD
P5193
JOSHI, RAVI VIVEKANAND, MD
1/4/2013
P6033
MCDOWELL, AMANDA , MD
4/1/2013
6/4/2010
6/3/2011
9/1/2011
6/4/2015 CARDIOLOGY
6/3/2016 CARDIOLOGY
9/1/2016 CARDIOLOGY
12/17/2012 12/17/2017 CARDIOLOGY
12/17/2012 12/17/2017 CARDIOLOGY
12/17/2012 12/17/2017 CARDIOLOGY
2/5/2010
4/8/2011
11/1/2012
11/30/2012
N8088
DE GROOT, PATRICIA M, MD
11/15/2010
P1618
ARASHVAND, MOJGAN, DO
12/15/2011
FORT SAM
TX
VASCULAR MEDICINE
MUSKOGEE
OK
INTERNAL MEDICINE
INTERNAL MEDICINE TEMPLE
TX
TX
2/5/2015 CARDIOLOGY
4/8/2016 CARDIOLOGY
CARDIOTHORACIC
CARDIOTHORACIC
CARDIOTHORACIC
CARDIOTHORACIC
11/15/2015 RADIOLOGY
CARDIOVASCULAR
12/15/2016 DISEASES
CARDIOVASCULAR
12/15/2016 DISEASES
P1622
ASAD, MUHAMMAD , MD
12/15/2011
N1535
ASFOUR, ABEDELRAHIM, MD
CARDIOVASCULAR
12/12/2008 12/12/2013 DISEASES
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/26/2011 None
N/A
ACTIVE
1/12/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
9/24/2012 None
N/A
6/4/2010 None
1/4/2012 None
N/A
N/A
6/4/2010 None
N/A
6/4/2010 None
11/5/2010 None
N/A
N/A
6/3/2011 None
12/1/2011 None
N/A
N/A
12/17/2012 None
1/22/2013 None
1/22/2013 None
N/A
N/A
N/A
2/5/2010 None
N/A
INTERNAL MEDICINE CHICAGO
IL
ACTIVE
ACTIVE
4/22/2011 None
11/29/2012 None
N/A
N/A
ANESTHESIOLOGY
ANESTHESIOLOGY
HOUSTON
SAN
FRANCISCO
TX
ACTIVE
12/5/2012 None
N/A
CA
ACTIVE
1/8/2013 None
N/A
HOUSTON
TX
ACTIVE
4/12/2013 None
N/A
DIAGNOSTIC
RADIOLOGY
RICHMOND
VA
ACTIVE
LICENSE
ISSUED
12/6/2010 None
N/A
12/15/2011 None
N/A
INTERVENTIONAL
CARDIOLOGY
THE
WOODLANDS TX
12/29/2011 None
N/A
9/30/2009 None
N/A
INTERVENTIONAL
CARDIOLOGY
Page 23 of 301
ACTIVE
DELINQUEN
T-NON
PAYMENT
License
Number
Physician Name
N7903
BADERO, OLUROTIMI JOHN, MD
P4421
BENZ, MICHAEL, MD
N5573
BHARGAVA, SANJAY, MD
P7256
CAUTHEN, CLAY ADAMS, MD
P7409
CHAKILAM, SRUJANA, MD
N9437
CHAKRAVARTHY, MITHUN, MD
N6221
CHIADIKA, SIMBO M, MD
N9843
DIAZ, TULIO, MD
P5173
DIESTEL, ECKHART, MD
P0202
ENG, MARVIN HO-KEUNG, MD
N7264
GOLI, ANIL KUMAR, MD
P6170
GORE, MARIA ODETTE, MD
P4762
HADDADIAN, BABAK, MD
P1317
HAEUSSLEIN, ERNEST A, MD
P1762
HAMZEH, IHAB, MD
L4420
HANIF, BASHIR, MD
P5822
JEROUDI, AHMAD MOHAMED, MD
P2694
JOURNIGAN, JOANN G, MD
P6007
KEYLANI, ABDUL, MD
P0624
LIM, HAJIN, MD
edicaid
edicaid
End Date
Designated)
CARDIOVASCULAR
10/15/2010 10/15/2015 DISEASES
CARDIOVASCULAR
9/17/2012
9/17/2017 DISEASES
CARDIOVASCULAR
4/9/2010
4/9/2015 DISEASES
CARDIOVASCULAR
7/15/2013
7/15/2018 DISEASES
CARDIOVASCULAR
8/1/2013
8/1/2018 DISEASES
CARDIOVASCULAR
4/15/2011
4/15/2016 DISEASES
CARDIOVASCULAR
6/4/2010
6/4/2015 DISEASES
CARDIOVASCULAR
6/3/2011
6/3/2016 DISEASES
CARDIOVASCULAR
1/4/2013
1/4/2018 DISEASES
CARDIOVASCULAR
7/1/2011
7/1/2016 DISEASES
CARDIOVASCULAR
8/2/2010
8/2/2015 DISEASES
CARDIOVASCULAR
4/12/2013
4/12/2018 DISEASES
CARDIOVASCULAR
11/1/2012
11/1/2017 DISEASES
CARDIOVASCULAR
11/4/2011
11/4/2016 DISEASES
CARDIOVASCULAR
1/2/2012
1/2/2017 DISEASES
CARDIOVASCULAR
6/8/2012
6/8/2017 DISEASES
CARDIOVASCULAR
3/15/2013
3/15/2018 DISEASES
CARDIOVASCULAR
4/2/2012
4/2/2017 DISEASES
CARDIOVASCULAR
4/1/2013
4/1/2018 DISEASES
CARDIOVASCULAR
8/1/2011
8/1/2016 DISEASES
Secondary Specialty
(Self-Designated)
Practice City
NEPHROLOGY
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
JERSEY CITY
OTHER SPECIALTY
AUSTIN
Registration
Status of
Practice
Texas
State
License
NJ
TX
INTERNAL MEDICINE FORT WORTH TX
INTERNAL MEDICINE
CARDIOVASCULAR
IMAGING
INTERVENTIONAL
CARDIOLOGY
ARLINGTON
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
10/20/2010 None
N/A
ACTIVE
LICENSE
ISSUED
10/22/2012 None
N/A
4/9/2010 None
N/A
8/7/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/13/2013 None
N/A
4/15/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/16/2011 None
N/A
1/4/2013 None
N/A
ACTIVE
ELECTROPHYSIOLO
GY
HARLINGEN
TX
ACTIVE
8/9/2011 None
N/A
ACTIVE
8/13/2010 None
N/A
TX
ACTIVE
4/17/2013 None
N/A
INTERNAL MEDICINE LACROSSE
WI
ACTIVE
11/8/2012 None
N/A
ACTIVE
11/7/2011 None
N/A
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
Page 24 of 301
HOUSTON
TX
ACTIVE
1/16/2012 None
N/A
PARIS
TX
ACTIVE
6/12/2012 None
N/A
ATLANTA
GA
ACTIVE
3/22/2013 None
N/A
MCKINNEY
TX
ACTIVE
4/6/2012 None
N/A
FORT WORTH TX
ACTIVE
4/17/2013 None
N/A
ACTIVE
8/9/2011 None
N/A
License
Number
Physician Name
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
CARDIOVASCULAR
6/15/2011
6/15/2016 DISEASES
INTERNAL MEDICINE
P0088
MACWAR, RACHID RYAN, MD
H9391
OGHAFUA, GREGSON OROBOSA,
MD
J4425
PATHAN, ASAD Z, MD
4/1/2013
P5712
QUIROZ, RENE, MD
RAJAPREYAR, INDRANEE
NAMASIVAYAM, MD
3/1/2013
P7337
6/15/2011
7/15/2013
P2763
RAMANATH, VIJAY SITHARAM, MD
4/2/2012
P7549
RANGANATH, RAMAKRISHNAN, MD
8/1/2013
P6508
RAZA, SYED ARMAN, MD
5/1/2013
CARDIOVASCULAR
6/15/2016 DISEASES
CARDIOVASCULAR
4/1/2018 DISEASES
CARDIOVASCULAR
3/1/2018 DISEASES
CARDIOVASCULAR
7/15/2018 DISEASES
CARDIOVASCULAR
4/2/2017 DISEASES
CARDIOVASCULAR
8/1/2018 DISEASES
CARDIOVASCULAR
5/1/2018 DISEASES
P7558
ROSE, CARY, MD
8/1/2013
8/1/2018
L3461
7/1/2010
7/1/2015
N5380
SAEED, IBRAHIM MUHAMMAD, MD
SARAVANAN, SIRUMUGAI
MUTHUSWAMY , MD
2/5/2010
2/5/2015
P3076
SIDDIQI, NAUMAN, MD
5/1/2012
5/1/2017
P1231
SOMA, VIKAS REDDY, MD
N9779
SRIVASTAVA, NALIN KUMAR, MD
5/16/2011
5/16/2016
N4837
WARREN, JAMES KEITH , MD
11/6/2009
11/6/2014
P5249
YARLAGADDA, ANITHA, MD
1/4/2013
1/4/2018
N5498
YOHO, JASON ALLEN, MD
2/5/2010
2/5/2015
6/3/2013
6/3/2018
7/1/2013
7/1/2018
P6839
JOLLY, AARON FRANCIS, MD
NEWMAN, JACK NATHANIEL JR,
TM00546 MD
10/17/2011 10/17/2016
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
IMAGING
CARDIOVASCULAR
IMAGING
Practice City
INTERNAL MEDICINE ROCKWALL
INTERVENTIONAL
CARDIOLOGY
HOUSTON
VASCULAR MEDICINE BOSTON
HOUSTON
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
INTERVENTIONAL
CARDIOLOGY
CARDIAC
ELECTROPHYSIOLO
GY
INTERNAL MED PEDS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TEXAS
LICENSE
TX
ISSUED
TEXAS
LICENSE
TX
ISSUED
6/15/2011 None
N/A
6/15/2011 None
N/A
4/1/2013 None
N/A
MA
ACTIVE
3/15/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/15/2013 None
N/A
4/2/2012 None
N/A
ACTIVE
8/7/2013 None
N/A
KINGWOOD
TX
ACTIVE
5/29/2013 None
N/A
LONGVIEW
TX
ACTIVE
8/5/2013 None
N/A
7/13/2010 None
N/A
2/5/2010 None
N/A
5/4/2012 None
N/A
INTERNAL MEDICINE KYLE
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
IL
ACTIVE
LICENSE
ISSUED
11/16/2011 None
N/A
5/16/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/18/2009 None
N/A
1/4/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
6/18/2013 None
N/A
ACTIVE
7/11/2013 None
N/A
TX
INTERNAL MEDICINE
INTERNAL MEDICINE
Page 25 of 301
Disciplinary
Status Date
SPRINGFIELD MA
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
IRVING
INTERVENTIONAL
CARDIOLOGY
URBANAI
CARDIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
CARDIOVASCULAR
P6761
AGNONE, JOHN HENRY, MD
6/3/2013
6/3/2018 SURGERY
CARDIOVASCULAR
N0642
BENNETT, ROBERT DANIEL, MD
8/29/2008
8/29/2013 SURGERY
CARDIOVASCULAR
N1301
DAVIS, JOHN WILLIAM III, MD
10/10/2008 10/10/2013 SURGERY
CARDIOVASCULAR
P0040
DONOHUE, THOMAS A, MD
6/15/2011
6/15/2016 SURGERY
EISENBERG, STEVEN BERNARD,
CARDIOVASCULAR
G3324
MD
8/2/2010
8/2/2015 SURGERY
CARDIOVASCULAR
N3678
GONGORA, ENRIQUE, MD
8/21/2009
8/21/2014 SURGERY
GONZALEZ-STAWINSKI, GONZALO
CARDIOVASCULAR
P2654
VICENTE, MD
4/2/2012
4/2/2017 SURGERY
CARDIOVASCULAR
N6893
JAYAKAR, DAVID V, MD
7/1/2010
7/1/2015 SURGERY
CARDIOVASCULAR
P3022
KONDA, SUBBAREDDY, MD
5/1/2012
5/1/2017 SURGERY
CARDIOVASCULAR
P4594
MIKHAIL, PETER, MD
10/1/2012
10/1/2017 SURGERY
MISSELBECK, TIMOTHY SCOTT,
CARDIOVASCULAR
N5250
MD
2/5/2010
2/5/2015 SURGERY
CARDIOVASCULAR
N8699
O'HARA, WALTER WALDO JR, MD
2/4/2011
2/4/2016 SURGERY
CARDIOVASCULAR
P5461
ROSENGART, TODD KENNETH, MD
2/1/2013
2/1/2018 SURGERY
CARDIOVASCULAR
P3074
SHAFII, ALEXIS EDWARD, MD
5/1/2012
5/1/2017 SURGERY
P5891
SHAKIR, HUZAIFA ABBAS, MD
3/15/2013
3/15/2018
N7883
SWAIN, TIMOTHY WHITZEL III, MD
10/1/2010
10/1/2015
P2939
ADEOYE, MARTINS ADEMOLA, MD
5/1/2012
5/1/2017
P1445
ATRI, ASHUTOSH , MD
11/15/2011 11/15/2016
CARDIOVASCULAR
SURGERY
CARDIOVASCULAR
SURGERY
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
Secondary Specialty
(Self-Designated)
Practice City
SHERMAN
THORACIC SURGERY CONROE
THORACIC SURGERY HOUSTON
TRANSPLANT
SURGERY
TEMPLE
TRANSPLANT
SURGERY
DALLAS
VASCULAR
SURGERY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
GENERAL VASCULAR
SURGERY
PASSAIC
CORPUS
CHRISTI
Page 26 of 301
11/13/2008 None
N/A
11/3/2008 None
N/A
6/15/2011 None
N/A
N/A
TX
ACTIVE
10/5/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
4/9/2012 None
N/A
7/1/2010 None
N/A
ACTIVE
6/4/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/3/2012 None
N/A
2/5/2010 None
N/A
2/4/2011 None
N/A
TX
ACTIVE
2/11/2013 None
N/A
TX
ACTIVE
5/25/2012 None
N/A
NJ
ACTIVE
3/21/2013 None
N/A
TX
ACTIVE
10/5/2010 None
N/A
5/1/2012 None
N/A
11/17/2011 None
N/A
LICENSE
ISSUED
HOUSTON
N/A
8/5/2010 None
PSYCHIATRY
PSYCHIATRY
6/3/2013 None
ACTIVE
GENERAL SURGERY
CARDIOVASCULAR
SURGERY
GENERAL SURGERY DALLAS
Disciplinary
Status Date
TX
THORACIC SURGERY ROUND ROCK TX
WICHITA
THORACIC SURGERY FALLS
TX
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
License
Number
Physician Name
N7527
BROWN, DAWN KAMILAH, MD
N6257
DIEDERICH, ANDREW DAVID, MD
N6410
KARNIK, ANITA DILIP, MD
P5417
MANSOURKHANI, SHIVA , MD
N9611
MUNIR, SYED MUZAFFAR, MD
P2753
PARROTT, JUSTIN JAMES, MD
N7331
QUINTANA, HUMBERTO, MD
P2767
RAZA, SHAKEEL, MD
H9710
SCOTT, PHILIP L, DO
H8837
SHREEVE, DANIEL FREDERICK,
MD
P6273
SIDDIQUI, KIRAN F, MD
P0935
TSOURMAS, JESSICA E, MD
P7045
VARGHEES, SEEMA SUSAN, MD
edicaid
edicaid
End Date
Designated)
CHILD AND
ADOLESCENT
8/27/2010
8/27/2015 PSYCHIATRY
CHILD AND
ADOLESCENT
6/4/2010
6/4/2015 PSYCHIATRY
CHILD AND
ADOLESCENT
6/4/2010
6/4/2015 PSYCHIATRY
CHILD AND
ADOLESCENT
2/1/2013
2/1/2018 PSYCHIATRY
CHILD AND
ADOLESCENT
5/2/2011
5/2/2016 PSYCHIATRY
CHILD AND
ADOLESCENT
4/2/2012
4/2/2017 PSYCHIATRY
CHILD AND
ADOLESCENT
8/2/2010
8/2/2015 PSYCHIATRY
CHILD AND
ADOLESCENT
4/2/2012
4/2/2017 PSYCHIATRY
CHILD AND
ADOLESCENT
12/12/2008 12/12/2013 PSYCHIATRY
CHILD AND
ADOLESCENT
8/15/2013
CHILD AND
ADOLESCENT
4/12/2013
CHILD AND
ADOLESCENT
9/1/2011
9/1/2016 PSYCHIATRY
CHILD AND
ADOLESCENT
6/14/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
PSYCHIATRY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
9/1/2010 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
PSYCHIATRY
LICENSE
ISSUED
6/4/2010 None
N/A
PSYCHIATRY
ACTIVE
2/25/2013 None
N/A
PSYCHIATRY
LICENSE
ISSUED
5/2/2011 None
N/A
ACTIVE
4/10/2012 None
N/A
ACTIVE
8/30/2010 None
N/A
PSYCHIATRY
ABILENE
TX
PSYCHIATRY
PSYCHIATRY
MOBILE
AL
ACTIVE
4/6/2012 None
N/A
PSYCHIATRY
TEMPLE
TX
ACTIVE
1/9/2009 None
N/A
PSYCHIATRY
GEORGETOW
N
TX
ACTIVE
8/19/2013 None
N/A
LICENSE
ISSUED
4/12/2013 None
N/A
PSYCHIATRY
PSYCHIATRY
Page 27 of 301
AUSTIN
TX
ACTIVE
9/13/2011 None
N/A
TEMPLE
TX
ACTIVE
6/21/2013 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N3428
AKMAN, CIGDEM INAN, MD
8/21/2009
8/21/2014 CHILD NEUROLOGY
N7054
ATKINSON, SIDNEY WRIGHT, MD
7/15/2010
N4413
N2088
FOSTER, TIMOTHY CHARLES, MD
GOLLA, SAILAJA , MD
11/6/2009
2/6/2009
P5534
HOLDER, JIMMY LLOYD JR, MD
2/8/2013
P5380
P1189
N2673
HOLLER-MANAGAN, YOLANDA, MD
KHOURY, CHAOUKI K, MD
MORENO, MIGUEL ANDRES, MD
P7820
P1579
NEIL, ERIN ELIZABETH, DO
PEARLMAN, MICHAEL L, MD
2/1/2013
10/17/2011 10/17/2016 CHILD NEUROLOGY
4/3/2009
8/30/2013
12/1/2011
N1895
SIRSI, DEEPA , MD
P0344
BEKHEIRNIA, MIR REZA , MD
7/15/2011
P1555
KATUNA, BRUCE ALAN, MD
12/1/2011
12/12/2008 12/12/2013 CHILD NEUROLOGY
7/15/2016 CLINICAL GENETICS
CLINICAL
12/1/2016 NEUROPHYSIOLOGY
N6366
HUI, SHIU-KI ROCKY, MD
6/4/2010
6/4/2015
P6341
BOOSTROM, SARAH YORK, MD
5/1/2013
5/1/2018
N4320
11/6/2009
11/6/2014
N5634
CALI, REBECCA LAMAR, MD
CONNAUGHTON, JAMES
CHRISTOPHER, MD
4/9/2010
4/9/2015
P4560
DAS, BIDHAN, MD
10/1/2012
10/1/2017
P4864
ESSANI, RAHILA, MD
N7542
GAJJAR, AAKASH HASMUKH, MD
11/15/2012 11/15/2017
8/27/2010
8/27/2015
Secondary Specialty
(Self-Designated)
Practice City
CLINICAL
NEUROPHYSIOLOGY HOUSTON
NEUROLOGY
NEURODEVELOPMEN
TAL DISABILITIES
(PEDIATRICS)
HOUSTON
PEDIATRICS
DALLAS
NEUROLOGY
NEUROMUSCULAR
DISEASE
NEURO-ONCOLOGY
TX
TX
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/1/2009 None
N/A
7/15/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
11/13/2009 None
2/18/2009 None
N/A
N/A
2/8/2013 None
N/A
DALLAS
EL PASO
TX
TX
ACTIVE
ACTIVE
ACTIVE
2/5/2013 None
10/28/2011 None
4/14/2009 None
N/A
N/A
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
9/2/2013 None
12/7/2011 None
N/A
N/A
TX
ACTIVE
12/17/2008 None
N/A
TX
ACTIVE
7/25/2011 None
N/A
CO
ACTIVE
12/6/2011 None
N/A
6/4/2010 None
N/A
DALLAS
TX
LICENSE
ISSUED
LICENSE
ISSUED
5/1/2013 None
N/A
TANEYTOWN
MD
ACTIVE
2/5/2010 None
N/A
SAN ANTONIO TX
ACTIVE
5/3/2010 None
N/A
HOUSTON
TX
ACTIVE
10/26/2012 None
N/A
TEMPLE
TX
ACTIVE
12/3/2012 None
N/A
GALVESTON
TX
ACTIVE
9/1/2010 None
N/A
CLINICAL
NEUROPHYSIOLOGY DALLAS
CLINICAL
MOLECULAR
GENETICS
HOUSTON
BLOOD
BANKING/TRANSFUSI
CLINICAL PATHOLOGY ON MEDICINE
COLON AND RECTAL
SURGERY
COLON AND RECTAL
SURGERY
COLON AND RECTAL
SURGERY
GENERAL SURGERY
COLON AND RECTAL
SURGERY
GENERAL SURGERY
COLON AND RECTAL
SURGERY
GENERAL SURGERY
COLON AND RECTAL
SURGERY
GENERAL SURGERY
Page 28 of 301
Registration
Status of
Practice
Texas
State
License
LONGMONT
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
COLON AND RECTAL
11/6/2009
11/6/2014 SURGERY
COLON AND RECTAL
4/9/2010
4/9/2015 SURGERY
COLON AND RECTAL
3/15/2012
3/15/2017 SURGERY
COLON AND RECTAL
7/1/2010
7/1/2015 SURGERY
COLON AND RECTAL
7/1/2010
7/1/2015 SURGERY
COLON AND RECTAL
4/2/2012
4/2/2017 SURGERY
COLON AND RECTAL
8/30/2013
8/30/2018 SURGERY
COLON AND RECTAL
1/3/2011
1/3/2016 SURGERY
N4430
GLASGOW, SEAN C, MD
J6468
P2469
GORDON, LORI LYNN, MD
KEELING-JOHNSON, KONYA
KAVITA, MD
N6906
LAKSHMAN, THIRU VENKAT, MD
N6915
LODHA, ANAND KUMAR, MD
P2746
NOVOSAD, LAURIE SUSAN, MD
P7846
SANDERS, BRIDGET MARIE, MD
N8455
SARMA, DEBA, MD
P0896
BUCHANAN, EDWARD PATRICK,
MD
9/1/2011
CRANIOFACIAL
9/1/2016 SURGERY
P5350
CONE, JEFFREY DONALD JR, MD
2/1/2013
CRANIOFACIAL
2/1/2018 SURGERY
P0035
DERDERIAN, CHRISTOPHER
ARMEN, MD
6/15/2011
CRANIOFACIAL
6/15/2016 SURGERY
N2556
N7016
N8228
HARSHBARGER, RAYMOND
JACKSON III, MD
VARKARAKIS, GEORGE MICHAEL,
MD
4/3/2009
7/1/2010
P6669
NAHOURAII, RICHARD A, MD
LACHMANSINGH, JINESH
STEPHAN, MD
12/1/2010
N5265
MOULIN, VICTOR GREGOIRE, MD
N7087
GANDHI, MIHIRKUMAR, MD
7/15/2010
P6655
KHAN, ASJAD MASOOD, MD
5/15/2013
5/15/2013
2/5/2010
CRANIOFACIAL
4/3/2014 SURGERY
CRANIOFACIAL
7/1/2015 SURGERY
CRITICAL CARE
12/1/2015 (TRAUMA)
CRITICAL CARE
CRITICAL CARE
CRITICAL CARE
7/15/2015 MEDICINE
CRITICAL CARE
5/15/2018 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
LACKLAND
GENERAL SURGERY AFB
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
11/16/2009 None
N/A
FORT WORTH TX
ACTIVE
4/20/2010 None
N/A
GENERAL SURGERY MESA
AZ
ACTIVE
3/26/2012 None
N/A
GENERAL SURGERY AUSTIN
TX
ACTIVE
7/15/2010 None
N/A
TX
ACTIVE
7/27/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/4/2012 None
N/A
8/30/2013 None
N/A
1/3/2011 None
N/A
GENERAL SURGERY
GENERAL SURGERY
PLASTIC &
RECONSTRUCTIVE
SURGERY
PLASTIC &
RECONSTRUCTIVE
SURGERY
PLASTIC &
RECONSTRUCTIVE
SURGERY
PLASTIC &
RECONSTRUCTIVE
SURGERY
PLASTIC SURGERY
HOUSTON
TX
ACTIVE
9/15/2011 None
N/A
TAMPA
FL
ACTIVE
2/11/2013 None
N/A
DALLAS
TX
ACTIVE
6/20/2011 None
N/A
AUSTIN
TX
ACTIVE
4/8/2009 None
N/A
DALLAS
TX
ACTIVE
7/7/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
1/11/2011 None
N/A
5/15/2013 None
N/A
2/5/2010 None
N/A
7/15/2010 None
N/A
6/3/2013 None
N/A
GENERAL SURGERY HOUSTON
ANESTHESIOLOGY
ANESTHESIOLOGY
INTERNAL MEDICINE JOPLIN
Page 29 of 301
MO
ACTIVE
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
CRITICAL CARE
N5828
MAJID, HASHIR , MD
4/9/2010
4/9/2015 MEDICINE
CRITICAL CARE
N4745
SHIBER, JOSEPH R, MD
11/6/2009
11/6/2014 MEDICINE
TROXCLAIR, SEAN KRISTOFOR ,
CRITICAL CARE
N3359
MD
5/29/2009
5/29/2014 MEDICINE
CRITICAL CARE
P7607
AWAN, RINA NAZIR, MD
8/15/2013
8/15/2018 MEDICINE (IM)
CRITICAL CARE
N0628
BANGALORE, DEEPA , MD
8/29/2008
BURDICK, CHRISTOPHER JOSEPH,
CRITICAL CARE
P7081
MD
7/1/2013
CRITICAL CARE
N3533
CANTWELL, WILLIAM SCOTT , MD
8/21/2009
P1531
CLARK, CHERYL ANN, MD
12/1/2011
N9210
GHOSH, PRITAM , MD
N0791
GLEASON, BONNIE T, MD
8/29/2008
K3313
11/4/2011
P1941
LOUBE, DANIEL, MD
UDEOZO, OBIORA IGWEDUMMA,
MD
N3443
AMMAR, NEAL , MD
8/21/2009
N2919
5/29/2009
N9195
AMMAR, SHERIF , MD
COOK-NORRIS, ROBERT HARRY,
MD
P1178
EL TAL, ABDEL KADER , MD
10/17/2011
N5051
FERNANDEZ, GEOVER , MD
2/5/2010
P2988
FOX, MATTHEW C, MD
5/1/2012
P2999
HEXSEL FOLK, CAMILE LUIZA, MD
5/1/2012
K2270
RITTER, STEVEN EKBERG, MD
4/1/2011
1/17/2012
4/1/2011
12/15/2011
CRITICAL CARE
CRITICAL CARE
CRITICAL CARE
CRITICAL CARE
CRITICAL CARE
DERMATOLOGIC
8/21/2014 SURGERY
DERMATOLOGIC
5/29/2014 SURGERY
DERMATOLOGIC
4/1/2016 SURGERY
DERMATOLOGIC
10/17/2016 SURGERY
DERMATOLOGIC
2/5/2015 SURGERY
DERMATOLOGIC
5/1/2017 SURGERY
DERMATOLOGIC
5/1/2017 SURGERY
DERMATOLOGIC
12/15/2016 SURGERY
Secondary Specialty
(Self-Designated)
PULMONARY
MEDICINE
INTERNAL MED EMERGENCY MED
Practice City
HOUSTON
INTERNAL MEDICINE TYLER
PULMONARY
DISEASES
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/9/2010 None
N/A
1/22/2010 None
N/A
6/9/2009 None
N/A
8/15/2013 None
N/A
10/23/2008 None
N/A
7/1/2013 None
N/A
PULMONARY
CRITICAL CARE
MEDICINE
HOLLYWOOD
PULMONARY
MEDICINE
TX
ACTIVE
8/31/2009 None
N/A
FL
ACTIVE
12/6/2011 None
N/A
ACTIVE
4/14/2011 None
N/A
PULMONARY
MEDICINE
SANTA ROSA
TX
ACTIVE
9/9/2008 None
N/A
CA
ACTIVE
11/17/2011 None
N/A
NEPHROLOGY
MI
ACTIVE
2/3/2012 None
N/A
CA
ACTIVE
10/22/2009 None
N/A
CA
ACTIVE
8/27/2009 None
N/A
ACTIVE
4/6/2011 None
N/A
10/18/2011 None
N/A
2/5/2010 None
N/A
OTOLARYNGOLOGY
ANN ARBOR
SANTA
MONICA
SANTA
MONICA
DERMATOLOGY
DERMATOLOGY
DEARBORN
MI
ACTIVE
LICENSE
ISSUED
DERMATOLOGY
AUSTIN
TX
ACTIVE
5/18/2012 None
N/A
DERMATOLOGY
HOUSTON
TX
ACTIVE
5/14/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/22/2011 None
N/A
DERMATOLOGY
Page 30 of 301
License
Number
Physician Name
N2882
WHITAKER, DUANE COLE, MD
N9158
ALBERTA-WSZOLEK, LAUREN, MD
N9338
ALI, SYED OMAR, MD
N9998
N9170
N3492
P3510
P0009
N2962
N8896
P3130
P0022
P2973
N6231
P2626
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
DERMATOLOGIC
4/3/2009
4/3/2014 SURGERY
DERMATOLOGY
4/1/2011
4/1/2016 DERMATOLOGY
4/8/2011
ALTMEYER, MARY DENNIS, MD
6/15/2011
BARTELL, HOLLY LEIGH, MD
BERLIN, ALEXANDER LEON, MD
BLAKE, PATRICK WILLIAM, MD
BLANCO, GABRIELA M, MD
BRANDON, KIRRA LINDSAY, MD
CARTER, DORNECHIA ELVERNA
GEORGE, MD
CAYCE, RACHAEL LYNN, MD
CHEN, KAREN, MD
CLOSE, CATHERINE COTTERMAN,
MD
4/1/2011
8/21/2009
6/8/2012
6/15/2011
5/29/2009
4/1/2016
8/21/2014
6/8/2017
6/15/2016
5/29/2014
3/1/2011
5/15/2012
6/15/2011
5/1/2012
DERMATOLOGY
DERMATOLOGY
DERMATOLOGY
DERMATOLOGY
DERMATOLOGY
P2228
CONROY, MELINDA DAWN, DO
DAO, HARRY JR, MD
DHARAMSI, JENNIFER WARNER,
MD
P5172
N7416
DIAZ, LUCIA ZORAIDA, MD
DIGIORGIO, CATHERINE, MD
1/4/2013
8/16/2010
P5796
DOUGHERTY, ALEXIS LEAH, MD
3/15/2013
P0829
GOMEZ-MEADE, CARLOS, DO
GORDON, JENNIFER ROSE
SHULTZ, MD
8/26/2011
2/1/2013
P5367
6/4/2010
4/2/2012
3/1/2012
P3343
HATTER, ALYN DALE, DO
6/1/2012
N5113
P0231
HOUSEWRIGHT, CHAD DAVID, MD
HUNT, CHRISTINE M, MD
2/5/2010
7/1/2011
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
4/21/2009 None
N/A
BELLAIRE
TX
ACTIVE
4/7/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/15/2011 None
N/A
6/15/2011 None
N/A
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/13/2011
8/28/2009
6/14/2012
6/20/2011
6/8/2009
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/18/2011 None
6/12/2012 None
6/20/2011 None
N/A
N/A
N/A
MIDLAND
TX
5/8/2012 None
N/A
CLEVELAND
OH
ACTIVE
LICENSE
ISSUED
ACTIVE
6/4/2010 None
4/10/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
3/8/2012 None
N/A
WEBSTER
SANTA
BARBARA
TX
ACTIVE
ACTIVE
1/14/2013 None
8/25/2010 None
N/A
N/A
CA
ACTIVE
3/21/2013 None
N/A
HOLLYWOOD
FL
ACTIVE
9/2/2011 None
N/A
AUSTIN
TX
ACTIVE
2/11/2013 None
N/A
LONGVIEW
TX
6/12/2012 None
N/A
LIVINGSTON
HOUSTON
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/5/2010 None
7/6/2011 None
N/A
N/A
ARLINGTON
DALLAS
HOUSTON
DERMATOLOGIC
SURGERY
DERMATOLOGIC
SURGERY
MOHS
MICROGRAPHIC
SURGERY
DERMATOLOGIC
SURGERY
DERMATOLOGIC
SURGERY
Page 31 of 301
Disciplinary
Status Date
PASADENA
DERMATOLOGIC
SURGERY
DERMATOPATHOLO
GY
DERMATOLOGIC
SURGERY
DERMATOLOGIC
SURGERY
PEDIATRIC
DERMATOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P7290
N7441
JAHAN-TIGH, RICHARD REZA, MD
KARNES, JONATHAN, MD
7/15/2013
8/16/2010
P2134
KAUFFMAN, JULIA ANNE, MD
2/10/2012
F1094
N7443
KEUER, EDWARD JOHN III, MD
KODAMA, ATSUKO , MD
2/1/2013
8/16/2010
N4537
LAMBERT, THOMAS JOSEPH II, MD
11/6/2009
P7300
LE, LIET NGOC, MD
N1740
LOFTIS, BRENT , DO
N7558
P6217
MAGEL, GEORGE DIMITRI, MD
MARTIN, JOHN MATTHEW IV, MD
N8690
MEHTA, ANITA, MD
7/15/2013
8/27/2010
4/12/2013
2/4/2011
MIR, MOHSIN REHMAN, MD
4/9/2010
P5691
MOORE, MILTON RAHMON, MD
3/1/2013
N7473
PATEL, MALINI , MD
8/16/2010
PATEL, PAYAL VINOD, DO
P5120
P5120
P5120
P1128
PECKHAM, RUSSELL , DO
PHAM, RYAN KHANHHOANG, DO
N9400
P5878
N9937
POURCIAU, CRYSTAL YVONNE, MD
PURYEAR, ANGEL SUN, MD
QUINTANILLA-DIECK, MARIA
JOSEFINA, MD
P7693
P1685
RAINS, MICHAEL LEROY, MD
RAMOLIA, PARAS BATUK, MD
3/15/2012
DERMATOLOGIC
SURGERY
DERMATOLOGIC
SURGERY
URGENT CARE
MEDICINE
MOHS
MICROGRAPHIC
SURGERY
12/17/2012 12/17/2017 DERMATOLOGY
12/17/2012 12/17/2017 DERMATOLOGY
12/17/2012 12/17/2017 DERMATOLOGY
10/3/2011
4/8/2011
3/15/2013
6/3/2011
7/15/2013 None
8/24/2010 None
N/A
N/A
2/14/2012 None
N/A
ACTIVE
ACTIVE
2/13/2013 None
8/24/2010 None
N/A
N/A
TYLER
ACTIVE
11/16/2009 None
N/A
ACTIVE
8/8/2013 None
N/A
DUNCANVILLE TX
ACTIVE
2/4/2009 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
LICENSE
ISSUED
9/17/2010 None
4/16/2013 None
N/A
N/A
2/4/2011 None
N/A
TX
HOUSTON
TX
ACTIVE
4/14/2010 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
3/26/2013 None
N/A
8/16/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
3/19/2012 None
N/A
MORRISTOWN NJ
PEDIATRIC
DERMATOLOGY
Page 32 of 301
Disciplinary
Status Date
ACTIVE
FT. HOOD
TX
FT. HOOD
TX
FORT WORTH TX
8/15/2013
12/15/2011 12/15/2016 DERMATOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
OAKBROOK
TERRACE
IL
FORT WORTH TX
DERMATOLOGIC
SURGERY
12/12/2008 12/12/2013 DERMATOLOGY
N5872
P2506
Secondary Specialty
(Self-Designated)
DERMATOPATHOLO
GY
FAMILY MEDICINE
DERMATOPATHOLO
GY
PEDIATRIC
DERMATOLOGY
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
PLANO
TX
DALLAS
TX
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
12/17/2012
1/17/2013
1/17/2013
10/4/2011
None
None
None
None
N/A
N/A
N/A
N/A
4/8/2011 None
3/20/2013 None
N/A
N/A
6/13/2011 None
N/A
8/15/2013 None
12/26/2011 None
N/A
N/A
License
Number
Physician Name
P3232
RAO, TARA ANANTHA, MD
edicaid
edicaid
End Date
Designated)
5/15/2012
P2352
RICHEY, JONATHAN D, DO
3/1/2012
N5361
N2268
RIDDLE, CHRISTY CATHLEEN, MD
ROTAN, EDWARD EARL JR, MD
2/5/2010
2/6/2009
P1400
P2921
11/4/2011
4/13/2012
N4727
SAAP, LILIANA J, MD
SAUCIER, JESSICA MARIE, MD
SCHAEFER, STEPHANIE MCLEISH,
MD
11/6/2009
P3578
N8983
SCRUGGS, JESSICA M, MD
SHAH, KEJAL RINOO, MD
6/8/2012
3/1/2011
N6669
SINGH, LOTIKA , MD
6/4/2010
P6922
N7752
SOUSA, TATIANA SILVA, MD
STEINMETZ, STEFFANY BROOKE,
DO
6/3/2013
9/15/2010
P7578
TARBOX, MICHELLE BABB, MD
8/1/2013
N8251
TONKOVIC-CAPIN, VISESLAV, MD
12/1/2010
P0313
TREEN, BEN MARCUS, MD
7/1/2011
N8257
WRIGHT, EDWARD DAVID, MD
12/1/2010
P1948
XIA, YANG, MD
1/17/2012
H9291
ABATI, ANDREA D, MD
12/15/2011
TM00360 DELGADO, RUBY, MD
6/4/2010
N5731
4/9/2010
N9908
HONDA, KORD, MD
MCLEMORE, MICHAEL STEVEN,
MD
P4852
CASTILLO, HEIDI, MD
6/3/2011
11/15/2012
Secondary Specialty
(Self-Designated)
Practice City
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
DERMATOLOGIC
SURGERY
FAMILY MEDICINE
ARLINGTON
DERMATOLOGIC
SURGERY
PROVIDENCE
LACKLAND
INTERNAL MEDICINE AFB
DERMATOLOGIC
SURGERY
DERMATOLOGIC
SURGERY
DERMATOPATHOLO
GY
DERMATOPATHOLO
GY
DERMATOLOGIC
SURGERY
DERMATOPATHOLO
GY
DERMATOLOGIC
SURGERY
DERMATOPATHOLOG
12/15/2016 Y
CYTOPATHOLOGY
DERMATOPATHOLOG
6/4/2015 Y
DERMATOPATHOLOG
4/9/2015 Y
DERMATOPATHOLOG ANATOMIC
6/3/2016 Y
PATHOLOGY
DEVELOPMENTALBEHAVIORAL
11/15/2017 PEDIATRICS
PEDIATRICS
Page 33 of 301
SUGAR LAND
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
5/22/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
RI
TX
ACTIVE
ACTIVE
11/28/2011 None
4/24/2012 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
11/16/2009 None
N/A
6/8/2012 None
3/28/2011 None
N/A
N/A
6/4/2010 None
N/A
TX
3/5/2012 None
N/A
2/5/2010 None
7/6/2009 None
N/A
N/A
TX
ACTIVE
6/4/2013 None
N/A
DUNCANVILLE TX
ACTIVE
9/21/2010 None
N/A
LUBBOCK
ACTIVE
8/13/2013 None
N/A
ACTIVE
12/30/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/25/2011 None
N/A
12/1/2010 None
N/A
1/17/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/20/2011 None
N/A
6/4/2010 None
N/A
4/9/2010 None
N/A
DOTHAN
ROCKVILLE
TX
AL
MD
HOUSTON
TX
ACTIVE
6/10/2011 None
N/A
HOUSTON
TX
ACTIVE
11/21/2012 None
N/A
License
Number
Physician Name
P4902
PORTER, JONATHAN CASTILLO,
MD
N0751
ERANI, DAVID MICHAEL, MD
P5917
ADKISON, JONATHAN SCOTT, MD
P1161
ARAS, OMER, MD
P2191
BAILEY, APRIL ALEXANDER, MD
N8165
BARGE, JAIDEEP UDAY, MD
P3286
BARNIDGE, MICHAEL JR, MD
N5558
BATHALA, ELIZABETH, MD
P6585
BAXTER, AARON JAMES, MD
P2590
BELL, MEGAN E, MD
BENVENISTE, MARCELO
KUPERMAN, MD
P4930
N6815
N4300
BERNSTEIN, MARC ALAN, MD
BLACKWELDER, JOHN TIMOTHY,
MD
F5838
BODE, JOHN NICHOLAS, DO
P1271
BOLD, JONATHAN WYATT, MD
N4955
BOOK, SCOTT GEORGE, MD
P4931
BOZORGI, FARSHID, MD
BROWNING, CAROL ANN
TENNENT, MD
CALLEROS MACIAS, JESUS
EDMUNDO , MD
P1168
P2423
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
11/15/2012 11/15/2017 PEDIATRICS
PEDIATRICS
ENDOCRINOLOGY,
DIABETES AND
8/29/2008
8/29/2013 DIABETES
METABOLISM
DIAGNOSTIC
4/1/2013
4/1/2018 RADIOLOGY
NEURO-RADIOLOGY
DIAGNOSTIC
10/17/2011 10/17/2016 RADIOLOGY
DIAGNOSTIC
3/1/2012
3/1/2017 RADIOLOGY
DIAGNOSTIC
INTERVENTIONAL
12/1/2010
12/1/2015 RADIOLOGY
RADIOLOGY
DIAGNOSTIC
INTERVENTIONAL
6/1/2012
6/1/2017 RADIOLOGY
RADIOLOGY
DIAGNOSTIC
4/9/2010
4/9/2015 RADIOLOGY
DIAGNOSTIC
INTERVENTIONAL
5/15/2013
5/15/2018 RADIOLOGY
RADIOLOGY
DIAGNOSTIC
INTERVENTIONAL
4/2/2012
4/2/2017 RADIOLOGY
RADIOLOGY
DIAGNOSTIC
11/30/2012 11/30/2017 RADIOLOGY
DIAGNOSTIC
INTERVENTIONAL
7/1/2010
7/1/2015 RADIOLOGY
RADIOLOGY
DIAGNOSTIC
11/6/2009
11/6/2014 RADIOLOGY
BREAST IMAGING
DIAGNOSTIC
11/30/2012 11/30/2017 RADIOLOGY
DIAGNOSTIC
11/4/2011
11/4/2016 RADIOLOGY
DIAGNOSTIC
2/5/2010
2/5/2015 RADIOLOGY
DIAGNOSTIC
11/30/2012 11/30/2017 RADIOLOGY
DIAGNOSTIC
10/17/2011 10/17/2016 RADIOLOGY
DIAGNOSTIC
INTERVENTIONAL
3/15/2012
3/15/2017 RADIOLOGY
RADIOLOGY
Page 34 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
11/21/2012 None
N/A
HOUSTON
TX
ACTIVE
9/12/2008 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
4/23/2013 None
N/A
10/17/2011 None
N/A
3/12/2012 None
N/A
12/21/2010 None
N/A
6/1/2012 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
CORPUS
CHRISTI
TX
ACTIVE
4/19/2010 None
N/A
HOUSTON
TX
ACTIVE
5/17/2013 None
N/A
SAN ANTONIO TX
ACTIVE
4/26/2012 None
N/A
HOUSTON
TX
ACTIVE
12/13/2012 None
N/A
ROCKFROD
IL
ACTIVE
7/14/2010 None
N/A
WALLA WALLA WA
ACTIVE
1/1/2010 None
N/A
PHOENIX
ACTIVE
12/11/2012 None
N/A
ACTIVE
LICENSE
ISSUED
11/17/2011 None
N/A
2/5/2010 None
N/A
AZ
EDEN PRAIRIE MN
LOS ANGELES CA
ACTIVE
1/7/2013 None
N/A
EDEN PRAIRIE MN
ACTIVE
12/16/2011 None
N/A
EL PASO
ACTIVE
3/23/2012 None
N/A
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N3542
CASTANEDA, WILFRIDO
ROLANDO, MD
P1975
CHAUDHARY, HUMERA M, MD
2/1/2012
N6838
CHINNAPPAN, RAJ , MD
7/1/2010
P1981
COOPER, JAMES KEITH, MD
2/1/2012
TM00508 CUNNEELY, KEVIN PATRICK, MD
P5058
DANG, MATTHEW K, MD
8/21/2009
5/1/2012
12/17/2012
P5058
DANG, MATTHEW K, MD
12/17/2012
P5058
DANG, MATTHEW K, MD
12/17/2012
P7422
DAVIS, RYAN WILLIAM, MD
P7757
DAY, CYNTHIA MADISON, MD
P4642
DEWITT, ROBERT MICHAEL, MD
P5355
DIAZ, JESUS RAFAEL, MD
2/1/2013
P2639
ELAMIR, HANNAH SAFIA, DO
4/2/2012
P1299
FAKIR, SAMI M, MD
11/4/2011
N4406
FAN, IAIN , DO
FIROUZTALE, PEJMAN AVRAHAM,
MD
11/6/2009
P0583
P5531
P5068
P5068
P5068
FRITTS, AARON HASKELL, MD
GODOY, MYRNA COBOS BARCO,
MD
MD
MD
8/1/2013
8/30/2013
10/15/2012
8/1/2011
2/8/2013
12/17/2012
12/17/2012
12/17/2012
DIAGNOSTIC
8/21/2014 RADIOLOGY
DIAGNOSTIC
2/1/2017 RADIOLOGY
DIAGNOSTIC
7/1/2015 RADIOLOGY
DIAGNOSTIC
2/1/2017 RADIOLOGY
DIAGNOSTIC
5/1/2017 RADIOLOGY
DIAGNOSTIC
DIAGNOSTIC
DIAGNOSTIC
DIAGNOSTIC
8/1/2018 RADIOLOGY
DIAGNOSTIC
8/30/2018 RADIOLOGY
DIAGNOSTIC
DIAGNOSTIC
2/1/2018 RADIOLOGY
DIAGNOSTIC
4/2/2017 RADIOLOGY
DIAGNOSTIC
11/4/2016 RADIOLOGY
DIAGNOSTIC
11/6/2014 RADIOLOGY
DIAGNOSTIC
8/1/2016 RADIOLOGY
DIAGNOSTIC
2/8/2018 RADIOLOGY
DIAGNOSTIC
DIAGNOSTIC
DIAGNOSTIC
Secondary Specialty
(Self-Designated)
ANGIOGRAPHY &
INTERVENTIONAL
RADIOLOGY
ABDOMINAL
RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
EL PASO
TX
EDMOND
OK
GOODLETTSVI
LLE
TN
NEURO-RADIOLOGY
NEURO-RADIOLOGY
EMERGENCY/TRAUM
A RADIOLOGY
THE
WOODLANDS TX
THE
WOODLANDS TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/10/2009 None
N/A
2/3/2012 None
N/A
7/1/2010 None
N/A
ACTIVE
2/16/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/10/2012 None
N/A
12/17/2012 None
N/A
ACTIVE
1/22/2013 None
N/A
ACTIVE
LICENSE
ISSUED
1/22/2013 None
N/A
8/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
9/9/2013 None
N/A
10/15/2012 None
N/A
ACTIVE
LICENSE
ISSUED
OTHER SPECIALTY
INTERVENTIONAL
RADIOLOGY
SAN ANTONIO TX
RADIOLOGY
EL PASO
TX
ACTIVE
2/28/2013 None
N/A
HOUSTON
TX
ACTIVE
4/4/2012 None
N/A
MI
ACTIVE
LICENSE
ISSUED
11/15/2011 None
N/A
11/6/2009 None
N/A
NUCLEAR MEDICINE DETROIT
INTERVENTIONAL
RADIOLOGY
CARDIOTHORACIC
RADIOLOGY
CARDIOTHORACIC
RADIOLOGY
CARDIOTHORACIC
RADIOLOGY
Page 35 of 301
ATLANTA
GA
ACTIVE
8/22/2011 None
N/A
PLANO
TX
ACTIVE
2/20/2013 None
N/A
HOUSTON
TX
ACTIVE
12/31/2012 None
N/A
HOUSTON
TX
ACTIVE
12/31/2012 None
N/A
HOUSTON
TX
ACTIVE
12/31/2012 None
N/A
P7121
edicaid
edicaid
Agreement Agreement Primary Specialty (SelfPhysician Name
Start Date
End Date
Designated)
DIAGNOSTIC
GOEL, NIRMIT, MD
3/1/2011
3/1/2016 RADIOLOGY
DIAGNOSTIC
GREBENC, MARY LORRAINE, MD
2/15/2011
2/15/2016 RADIOLOGY
DIAGNOSTIC
GROSSMAN, JULIA, MD
5/1/2012
5/1/2017 RADIOLOGY
GYVES-RAY, KATHERINE MARY,
DIAGNOSTIC
MD
4/9/2010
4/9/2015 RADIOLOGY
DIAGNOSTIC
HALABI, SAFWAN SAFAR, MD
4/9/2010
4/9/2015 RADIOLOGY
DIAGNOSTIC
HAYES, JODY COLEMAN, MD
9/17/2012
9/17/2017 RADIOLOGY
DIAGNOSTIC
HENDERSON, BENJAMIN REID, MD
7/1/2013
7/1/2018 RADIOLOGY
P3346
HERNANDEZ, RYAN JAMES, MD
P6637
HOANG, AMANDA PHAM, MD
5/15/2013
N4492
INGLE, DAVID J, DO
11/6/2009
License
Number
TM00420
TM00418
P2994
N5699
N5704
P4455
TM00426 JAIN, SHELLY, MD
6/1/2012
3/15/2011
P5389
JOHNSON, KELLY ANNE, MD
2/1/2013
N8525
KALAMBO, MEGAN JENKINS, MD
P5093
KELLY, MICHAEL JAMES, MD
12/17/2012
P5093
12/17/2012
P5093
12/17/2012
P6435
KLINGLESMITH, ROBERT E JR, MD
P4772
KOCH, CHRISTOPHER, MD
N6454
LEE, JAMES TE-AN, MD
1/18/2011
5/1/2013
11/1/2012
6/4/2010
DIAGNOSTIC
6/1/2017 RADIOLOGY
DIAGNOSTIC
5/15/2018 RADIOLOGY
DIAGNOSTIC
11/6/2014 RADIOLOGY
DIAGNOSTIC
3/15/2016 RADIOLOGY
DIAGNOSTIC
2/1/2018 RADIOLOGY
DIAGNOSTIC
1/18/2016 RADIOLOGY
DIAGNOSTIC
DIAGNOSTIC
DIAGNOSTIC
DIAGNOSTIC
5/1/2018 RADIOLOGY
DIAGNOSTIC
11/1/2017 RADIOLOGY
DIAGNOSTIC
6/4/2015 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
EDEN PRAIRIE MN
3/16/2011 None
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/7/2012 None
N/A
4/9/2010 None
N/A
4/9/2010 None
N/A
ACTIVE
9/24/2012 None
N/A
TX
ACTIVE
7/10/2013 None
N/A
TX
ACTIVE
6/4/2012 None
N/A
VA
ACTIVE
5/17/2013 None
N/A
KANSAS CITY MO
ACTIVE
2/4/2010 None
N/A
EDEN PRAIRIE MN
ACTIVE
4/12/2011 None
N/A
FAYETTEVILLE AR
ACTIVE
2/6/2013 None
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
2/4/2011 None
N/A
12/17/2012 None
N/A
DALLAS
BREAST IMAGING
INTERVENTIONAL
RADIOLOGY
TEXARKANA
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
PLANO
MANASSAS
TX
TX
EVANS
GA
ACTIVE
1/28/2013 None
N/A
EVANS
GA
ACTIVE
1/28/2013 None
N/A
HOUSTON
TX
ACTIVE
6/19/2013 None
N/A
11/27/2012 None
N/A
6/4/2010 None
N/A
EDEN PRAIRIE MN
Page 36 of 301
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
PEDIATRIC
RADIOLOGY
BREAST IMAGING
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
TM00452 LEVEY, MICHAEL STEVEN, MD
TM00494 LOEFFLER, PAUL MARK, MD
TM00542 LY, JUSTIN, MD
MAROULES, CHRISTOPHER
N9738
DANIEL, MD
MARSHALL, KELLEY WOODRUFF,
N5839
MD
P1566
MARTIN, PATRICIA, MD
N7142
MCDONALD, DAVID WILLIAM, MD
MESSIER, CHRISTOPHER BRIAN,
MD
N1767
TM00529 MILLMOND, STEVEN HARRIS, MD
N6496
MIRZA, RIZVAN ALLEN, MD
N1778
MOHAMMAD, FAWZI TAWFIC, MD
TM00348 MONTES, ARTHUR ANDREW, MD
P0446
MORALES, FRANCISCO J, MD
P0641
MORGAN, TIMOTHY GENE, DO
MORRISON, ROBERT STANLEY III,
MD
MUEHLENBEIN, STEPHEN JOSEPH,
TM00393 MD
P6874
TM00495 NATTELL, DANIEL F, MD
N5905
NEELA, SANGEETA , MD
N1811
ONETO, JULIETA MARIANA, MD
N5928
OWEN, ANN BURLESON, MD
edicaid
edicaid
End Date
Designated)
DIAGNOSTIC
7/1/2011
7/1/2016 RADIOLOGY
DIAGNOSTIC
12/15/2011 12/15/2016 RADIOLOGY
DIAGNOSTIC
5/15/2013
5/15/2018 RADIOLOGY
DIAGNOSTIC
5/16/2011
5/16/2016 RADIOLOGY
DIAGNOSTIC
4/9/2010
4/9/2015 RADIOLOGY
DIAGNOSTIC
12/1/2011
12/1/2016 RADIOLOGY
DIAGNOSTIC
7/15/2010
7/15/2015 RADIOLOGY
DIAGNOSTIC
12/12/2008 12/12/2013 RADIOLOGY
DIAGNOSTIC
11/1/2012
11/1/2017 RADIOLOGY
DIAGNOSTIC
6/4/2010
6/4/2015 RADIOLOGY
DIAGNOSTIC
12/12/2008 12/12/2013 RADIOLOGY
DIAGNOSTIC
4/9/2010
4/9/2015 RADIOLOGY
DIAGNOSTIC
7/15/2011
7/15/2016 RADIOLOGY
DIAGNOSTIC
8/1/2011
8/1/2016 RADIOLOGY
6/3/2013
10/1/2010
12/15/2011
4/9/2010
12/12/2008
4/9/2010
DIAGNOSTIC
6/3/2018 RADIOLOGY
DIAGNOSTIC
10/1/2015 RADIOLOGY
DIAGNOSTIC
DIAGNOSTIC
4/9/2015 RADIOLOGY
DIAGNOSTIC
DIAGNOSTIC
4/9/2015 RADIOLOGY
Secondary Specialty
(Self-Designated)
URGENT CARE
MEDICINE
PEDIATRIC
RADIOLOGY
NEURO-RADIOLOGY
PEDIATRIC
RADIOLOGY
Practice City
ACTIVE
7/6/2011 None
N/A
VISALIA
CA
ACTIVE
12/23/2011 None
N/A
POWAY
CA
ACTIVE
7/3/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
5/20/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
12/6/2011 None
N/A
7/15/2010 None
N/A
12/29/2008 None
N/A
11/6/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
1/1/2009 None
N/A
FOGELSVILLE PA
TX
ACTIVE
OH
ACTIVE
LICENSE
ISSUED
LAS VEGAS
NV
ACTIVE
4/29/2010 None
N/A
LAREDO
TX
ACTIVE
7/22/2011 None
N/A
DALLAS
TX
ACTIVE
8/5/2011 None
N/A
BEAUMONT
TX
ACTIVE
6/6/2013 None
N/A
UNION
SC
ACTIVE
10/11/2010 None
N/A
BIRMINGHAM
AL
ACTIVE
12/22/2011 None
N/A
ACTIVE
4/20/2010 None
N/A
ACTIVE
2/3/2009 None
N/A
ACTIVE
5/3/2010 None
N/A
RADIOLOGY
KENNER
Page 37 of 301
Disciplinary
Status Date
OH
NUCLEAR MEDICINE LYNDHURST
NEURO-RADIOLOGY
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
COLUMBUS
DALLAS
INTERVENTIONAL
RADIOLOGY
Registration
Status of
Practice
Texas
State
License
LA
License
Number
Physician Name
N7155
PALACIO URAN, DIANA MARIA, MD
N3224
PALISCH, ANDREW , MD
N8964
PALMER, ROBERT ANDREW, MD
P5702
PARMET, PHILLIP NOAH, MD
N1068
PHILLIPS, STEPHEN WAYNE, MD
N3255
QURESHI, JAVED , MD
P7837
RAHMAN, ARIF, MD
P6893
RAJU, ROMAN , MD
P6505
N2753
RAMOS-DURAN, LUIS RAUL, MD
REDDY, MADHUSUDHAN
POTHIREDDY, MD
N8975
REINSMITH, LANCE EDWARD, MD
N8713
RHEE, RICHARD JINHO, MD
P1952
ROFSKY, NEIL M, MD
ROSSMANN, MICHELLE DEBRA,
MD
P6714
TM00438 SAG, RANDY, MD
P4507
SALHAB, SAMER, MD
P0130
P2359
SANCHEZ, RICHARD, MD
SCOGGINS, MARION ELIZABETH,
MD
N6991
SEILER, STEPHEN JACOB, MD
P5002
SHEPHERD, SUZANNE MARIE, MD
edicaid
edicaid
End Date
Designated)
DIAGNOSTIC
7/15/2010
7/15/2015 RADIOLOGY
DIAGNOSTIC
5/29/2009
5/29/2014 RADIOLOGY
DIAGNOSTIC
3/1/2011
3/1/2016 RADIOLOGY
DIAGNOSTIC
3/1/2013
3/1/2018 RADIOLOGY
DIAGNOSTIC
8/29/2008
8/29/2013 RADIOLOGY
DIAGNOSTIC
5/29/2009
5/29/2014 RADIOLOGY
DIAGNOSTIC
8/30/2013
8/30/2018 RADIOLOGY
DIAGNOSTIC
6/3/2013
6/3/2018 RADIOLOGY
DIAGNOSTIC
5/1/2013
5/1/2018 RADIOLOGY
DIAGNOSTIC
4/3/2009
4/3/2014 RADIOLOGY
DIAGNOSTIC
3/1/2011
3/1/2016 RADIOLOGY
DIAGNOSTIC
2/4/2011
2/4/2016 RADIOLOGY
DIAGNOSTIC
1/17/2012
1/17/2017 RADIOLOGY
DIAGNOSTIC
5/15/2013
5/15/2018 RADIOLOGY
DIAGNOSTIC
4/15/2011
4/15/2016 RADIOLOGY
DIAGNOSTIC
9/17/2012
9/17/2017 RADIOLOGY
DIAGNOSTIC
6/15/2011
6/15/2016 RADIOLOGY
DIAGNOSTIC
3/1/2012
3/1/2017 RADIOLOGY
DIAGNOSTIC
7/1/2010
7/1/2015 RADIOLOGY
DIAGNOSTIC
11/30/2012 11/30/2017 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
MUSCULOSKELETAL
RADIOLOGY
BREAST IMAGING
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/15/2010 None
N/A
6/12/2009 None
N/A
3/1/2011 None
N/A
3/1/2013 None
N/A
HOUSTON
TX
ACTIVE
9/9/2008 None
N/A
VICTORIA
TX
ACTIVE
6/15/2009 None
N/A
ACTIVE
9/9/2013 None
N/A
NEURO-RADIOLOGY
HOUSTON
TX
FRIENDSWOO
D
TX
ACTIVE
6/7/2013 None
N/A
NEURO-RADIOLOGY
EL PASO
TX
ACTIVE
5/8/2013 None
N/A
WA
ACTIVE
6/29/2009 None
N/A
MO
ACTIVE
LICENSE
ISSUED
3/14/2011 None
N/A
2/4/2011 None
N/A
ACTIVE
2/16/2012 None
N/A
5/22/2013 None
N/A
4/15/2011 None
N/A
INTERVENTIONAL
RADIOLOGY
NUCLEAR MEDICINE KIRKLAND
MUSCULOSKELETAL
RADIOLOGY
SAINT LOUIS
NUCLEAR MEDICINE DALLAS
TX
EMERGENCY/TRAUM FARMINGTON
A RADIOLOGY
HILLS
MI
BIRMINGHAM
AL
ACTIVE
LICENSE
ISSUED
ATLANTA
GA
ACTIVE
10/4/2012 None
N/A
MARION
IN
ACTIVE
6/20/2011 None
N/A
HOUSTON
TX
ACTIVE
3/5/2012 None
N/A
TX
ACTIVE
7/12/2010 None
N/A
AL
ACTIVE
12/6/2012 None
N/A
DALLAS
MUSCULOSKELETAL
RADIOLOGY
BIRMINGHAM
Page 38 of 301
License
Number
N1150
TM00454
N5423
P1026
N6729
N7663
N9793
N9983
TM00496
P2174
N2889
P6152
P7653
N1372
N7312
N8849
P1839
N9993
P1955
P1956
edicaid
edicaid
Agreement Agreement Primary Specialty (SelfPhysician Name
Start Date
End Date
Designated)
DIAGNOSTIC
SIVAK, NATALIE LEILA MANGE, MD
8/29/2008
8/29/2013 RADIOLOGY
DIAGNOSTIC
SLOVES, JAMES HOWARD, MD
7/1/2011
7/1/2016 RADIOLOGY
DIAGNOSTIC
SWART, JENNIFER ESTELLE, MD
2/5/2010
2/5/2015 RADIOLOGY
DIAGNOSTIC
TAYLOR, LAURA ANN, MD
9/15/2011
9/15/2016 RADIOLOGY
DIAGNOSTIC
TUCKMAN, GLENN ANDREW, MD
6/4/2010
6/4/2015 RADIOLOGY
DIAGNOSTIC
WEINBERG, BRENT DEREK, MD
9/1/2010
9/1/2015 RADIOLOGY
DIAGNOSTIC
WHEELER, PAUL D, MD
5/16/2011
5/16/2016 RADIOLOGY
DIAGNOSTIC
WIESNER, JASON BILLINGS, MD
6/3/2011
6/3/2016 RADIOLOGY
WILLIAMS, RICHARD MALCOLM,
DIAGNOSTIC
MD
12/15/2011 12/15/2016 RADIOLOGY
DIAGNOSTIC
WU, FRANCIS MIEN LI, MD
2/10/2012
2/10/2017 RADIOLOGY
DIAGNOSTIC
YALLAMPALLI, SASIDHAR , MD
4/3/2009
4/3/2014 RADIOLOGY
ELECTROPHYSIOLOG
CHHABRA, SUMEET KUMAR, MD
4/12/2013
4/12/2018 Y
ELECTROPHYSIOLOG
JOSHI, RAJEEV , MD
8/15/2013
8/15/2018 Y
KOSHY-NESBITT, SUNITA SARA,
ELECTROPHYSIOLOG
MD
10/10/2008 10/10/2013 Y
ELECTROPHYSIOLOG
MEMON, NADA , MD
8/2/2010
8/2/2015 Y
SEGU, VENKATESH BABU
EMERGENCY
GOKULAN, MD
2/15/2011
2/15/2016 MEDICAL SERVICES
EMERGENCY
ABAWI, LAILAH MARIE, DO
1/17/2012
1/17/2017 MEDICINE
EMERGENCY
ADAMS, BENJAMIN DONALD, DO
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
ADAMS, TAJ CORDELL, MD
2/1/2012
2/1/2017 MEDICINE
EMERGENCY
ADEYEMO, FOYEKE ADEYELU, MD
2/1/2012
2/1/2017 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
CHAPEL HILL
Registration
Status of
Practice
Texas
State
License
NC
EDEN PRAIRIE MN
MUSCULOSKELETAL
RADIOLOGY
ATLANTA
NEURO-RADIOLOGY
GA
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
10/7/2008 None
N/A
ACTIVE
LICENSE
ISSUED
8/11/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
10/4/2011 None
N/A
6/4/2010 None
N/A
DALLAS
TX
ACTIVE
9/22/2010 None
N/A
SHERMAN
TX
ACTIVE
LICENSE
ISSUED
6/20/2011 None
N/A
6/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
1/3/2012 None
N/A
2/10/2012 None
N/A
SCOTTSDALE AZ
HOUSTON
TX
ACTIVE
4/27/2009 None
N/A
CARDIOLOGY
PLANO
TX
ACTIVE
4/25/2013 None
N/A
CARDIOLOGY
DALLAS
TX
ACTIVE
8/19/2013 None
N/A
ACTIVE
1/6/2009 None
N/A
ACTIVE
LICENSE
ISSUED
8/13/2010 None
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
1/30/2012 None
N/A
6/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
2/7/2012 None
N/A
2/1/2012 None
N/A
CARDIOLOGY
CARDIOLOGY
HOUSTON
TX
INTERNAL MEDICINE
LOCUM
TENENS
ATLANTA
EMERGENCY
MEDICINE
Page 39 of 301
OH
GA
License
Number
Physician Name
N8479
AHMED, ATHEER JAAFAR, MD
N4241
AKHLAGHI, MOHSEN , MD
P5020
AKUNYILI, EDOZIE JOHN, MD
P5020
P5020
P2088
ALDRICH, JOSEPH ALBERT III, DO
N6138
ALI, SYED SAMEER, MD
N7050
ALLEN, JOSHUA DEWAYNE, DO
N4248
ANDERSON, APRIL LAUREN, MD
P1159
ANDERSON, MELANIE RENEE, MD
P2188
ANDREWS, NICHOLE RENEE, MD
P0001
ANYANWU, CLEMENT, MD
H9755
APPEL, JEFFREY PAUL, MD
P6326
ARBOLEDA, ANDRES, MD
N8885
BALEZENTIS, SUSAN M, DO
N0625
BALLESTER, JOHN MICHAEL, MD
P2586
BANGALE, ANITA, MD
N7775
BANSAL, SONIA, MD
N4932
BARAK, ORY, MD
P6947
BARDWELL, STEVEN JOHN, DO
edicaid
edicaid
End Date
Designated)
EMERGENCY
1/18/2011
1/18/2016 MEDICINE
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
2/10/2012
2/10/2017 MEDICINE
EMERGENCY
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
7/15/2010
7/15/2015 MEDICINE
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
10/17/2011 10/17/2016 MEDICINE
EMERGENCY
3/1/2012
3/1/2017 MEDICINE
EMERGENCY
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
3/1/2011
3/1/2016 MEDICINE
EMERGENCY
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
EMERGENCY
10/1/2010
10/1/2015 MEDICINE
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
6/14/2013
6/14/2018 MEDICINE
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
Page 40 of 301
Disciplinary
Status Date
AUSTIN
TX
ACTIVE
1/25/2011 None
N/A
HOUSTON
TX
ACTIVE
2/1/2010 None
N/A
WOODLANDS TX
ACTIVE
1/7/2013 None
N/A
WOODLANDS TX
ACTIVE
1/7/2013 None
N/A
WOODLANDS TX
FORT
BENNING
GA
ACTIVE
1/7/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
2/20/2012 None
N/A
6/4/2010 None
N/A
7/15/2010 None
N/A
11/6/2009 None
N/A
EMERGENCY
MEDICINE
FAMILY MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
ACTIVE
11/1/2011 None
N/A
EL PASO
MOUNT
PLEASANT
TX
ACTIVE
3/20/2012 None
N/A
TX
ACTIVE
6/20/2011 None
N/A
DALLAS
TX
ACTIVE
8/28/2009 None
N/A
NASSAU BAY
TX
ACTIVE
5/8/2013 None
N/A
YONKERS
NY
ACTIVE
3/18/2011 None
N/A
MASON
FALLS
CHURCH
OH
ACTIVE
10/7/2008 None
N/A
VA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/11/2012 None
N/A
10/1/2010 None
N/A
2/5/2010 None
N/A
7/9/2013 None
N/A
FORT WORTH TX
ACTIVE
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
BARTON, JAMES BRADLEY
EMERGENCY
P3507
GUSTAF, MD
6/8/2012
6/8/2017 MEDICINE
EMERGENCY
P0341
BASSETT, ROBERT, DO
7/15/2011
7/15/2016 MEDICINE
EMERGENCY
N4287
BEADLE, SARAH MAY, MD
11/6/2009
11/6/2014 MEDICINE
BEARD, HEATHER LEANNE
EMERGENCY
P1848
NORRIS, DO
1/17/2012
1/17/2017 MEDICINE
EMERGENCY
P6336
BECK, ERIC HENRY, DO
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
N4290
BECKER, MARK OLIVER, MD
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
N4940
BECKFORD, TAMARA SHAKARI, MD
2/5/2010
2/5/2015 MEDICINE
BECKUM, ORLANDO KENDRICK,
EMERGENCY
P3121
MD
5/15/2012
5/15/2017 MEDICINE
EMERGENCY
P5033
BEER, B NICH, MD
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
P5033
BEER, B NICH, MD
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
P5033
BEER, B NICH, MD
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
P0546
BEERS, JEFFREY ROBERT, MD
8/1/2011
8/1/2016 MEDICINE
EMERGENCY
P5335
BEHZADI, PEDRAM AMIN, MD
2/1/2013
2/1/2018 MEDICINE
EMERGENCY
N9352
BELL, TODD DWAYNE, MD
4/8/2011
4/8/2016 MEDICINE
EMERGENCY
P6337
BERG, KRISTIN MARIE, MD
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
N9512
BERGER, TODD JASON, MD
5/2/2011
5/2/2016 MEDICINE
EMERGENCY
N6816
BERTORELLI, LUKE, DO
7/1/2010
7/1/2015 MEDICINE
EMERGENCY
N2404
BESSLER, ROBERT AARON, MD
4/3/2009
4/3/2014 MEDICINE
EMERGENCY
N6176
BEZEK, SARAH KATHLEEN, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
N4293
BHAKTA, NEETA SOORYA, MD
11/6/2009
11/6/2014 MEDICINE
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICINE
EMERGENCY
MEDICAL SERVICES
Practice City
Page 41 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
BEAUMONT
TX
ACTIVE
6/14/2012 None
N/A
FT. BLISS
TX
ACTIVE
8/12/2011 None
N/A
DALLAS
TX
ACTIVE
12/23/2009 None
N/A
FORT WORTH TX
ACTIVE
2/24/2012 None
N/A
DALLAS
TX
ACTIVE
6/26/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/25/2009 None
N/A
2/5/2010 None
N/A
5/15/2012 None
N/A
TEMPLE
TX
ACTIVE
1/3/2013 None
N/A
TEMPLE
TX
ACTIVE
1/3/2013 None
N/A
TEMPLE
TX
1/3/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
8/1/2011 None
N/A
GENEVA
NY
ACTIVE
2/5/2013 None
N/A
FORT HOOD
TX
ACTIVE
4/13/2011 None
N/A
HUMBLE
TX
ACTIVE
5/8/2013 None
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
5/5/2011 None
N/A
7/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/24/2009 None
N/A
6/4/2010 None
N/A
11/18/2009 None
N/A
AUBURN
EMERGENCY
MEDICINE
Registration
Status of
Practice
Texas
State
License
TEMPLE
WA
TX
ACTIVE
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
P4549
BISHOP, DENNIS MICHAEL, MD
10/1/2012
10/1/2017 MEDICINE
EMERGENCY
P1523
BLACK, JAMES EDWARD JR, MD
12/1/2011
12/1/2016 MEDICINE
EMERGENCY
N9813
BLAKE, BRIAN KELLY, DO
6/3/2011
6/3/2016 MEDICINE
EMERGENCY
P4424
BLANKENSHIP, ALAN LANE JR, MD
9/17/2012
9/17/2017 MEDICINE
EMERGENCY
P5597
BLYSTRA, ADAM CALVIN, DO
3/1/2013
3/1/2018 MEDICINE
EMERGENCY
N0655
BOLLINGER, ROBERT ALBIN II, DO
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
N4953
BOLTON, RYSCHELL RENEE, DO
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
N7231
BRAUN, AARON GREGORY, DO
8/2/2010
8/2/2015 MEDICINE
EMERGENCY
N1563
BROWN, AARON REED, MD
12/12/2008 12/12/2013 MEDICINE
EMERGENCY
P4851
BROWN, BENJAMIN JOHN, DO
11/15/2012 11/15/2017 MEDICINE
EMERGENCY
N7993
BROWN, ERIC MICHAEL, MD
10/29/2010 10/29/2015 MEDICINE
EMERGENCY
N0665
BROWN, JACOB WAYNE, MD
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
P6347
BROWN, ROBERT ALLEN JR, DO
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
N2964
BROWN-VARGAS, DAMARIS, DO
5/29/2009
5/29/2014 MEDICINE
EMERGENCY
N8769
BUCA, STEFAN COSMIN, MD
2/15/2011
2/15/2016 MEDICINE
EMERGENCY
N4965
BUCHANAN, BRYAN , MD
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
P3609
BURGBACHER, TODD EUGENE, DO
6/15/2012
6/15/2017 MEDICINE
EMERGENCY
P0962
BURK, KATHRYN JEAN, MD
9/15/2011
9/15/2016 MEDICINE
EMERGENCY
P4935
BURNETT, BRETT ALLEN, MD
11/30/2012 11/30/2017 MEDICINE
EMERGENCY
N3523
BURNS, KRISTINA PHYLLIS , MD
8/21/2009
8/21/2014 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
HOUSTON
TX
N/A
ACTIVE
LICENSE
ISSUED
2/17/2012 None
N/A
6/3/2011 None
N/A
ACTIVE
9/24/2012 None
N/A
HOUSTON
TX
ACTIVE
3/18/2013 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
9/11/2008 None
N/A
2/5/2010 None
N/A
HOUSTON
TX
ACTIVE
9/1/2010 None
N/A
PEARLAND
TX
ACTIVE
12/30/2008 None
N/A
ACTIVE
11/26/2012 None
N/A
DALLAS
TX
ACTIVE
11/3/2010 None
N/A
TEMPLE
TX
ACTIVE
9/16/2008 None
N/A
FT. HOOD
TX
ACTIVE
5/3/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
6/5/2009 None
N/A
2/15/2011 None
N/A
2/5/2010 None
N/A
6/15/2012 None
N/A
EMERGENCY
MEDICAL SERVICES
Page 42 of 301
10/15/2012 None
TX
URGENT CARE
MEDICINE
EMERGENCY
MEDICINE
Disciplinary
Status Date
DALLAS
EMERGENCY
MEDICINE
EMERGENCY
MEDICAL SERVICES
EMERGENCY
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
ACTIVE
10/31/2011 None
N/A
TEMPLE
TX
ACTIVE
12/11/2012 None
N/A
SAN MARCOS TX
ACTIVE
9/1/2009 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
N2425
BURNS, PAUL AARON, MD
4/3/2009
4/3/2014 MEDICINE
EMERGENCY
P5604
BUSKEN, MELISSA ROSA, MD
3/1/2013
3/1/2018 MEDICINE
EMERGENCY
N4317
CABALLERO, JOSHUA DAVID, MD
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
P1056
CABANAS, JOSE GUILLERMO, MD
10/3/2011
10/3/2016 MEDICINE
EMERGENCY
N7909
CAFFREY, THOMAS ARTHUR, MD
10/15/2010 10/15/2015 MEDICINE
EMERGENCY
P4635
CAIRE, SAMUEL RAHN, MD
10/15/2012 10/15/2017 MEDICINE
EMERGENCY
N8892
CALABRO, JAMES ANTHONY, MD
3/1/2011
3/1/2016 MEDICINE
EMERGENCY
P0557
CALERO, SHANNA MICHELLE, MD
8/1/2011
8/1/2016 MEDICINE
EMERGENCY
N5602
CAMERON, DAVID GLEN III, DO
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
N7686
CAMPBELL, MITRA MARGARET, DO
9/15/2010
9/15/2015 MEDICINE
CAMP-ROGERS, TERESA
EMERGENCY
P3514
RANDELLE, MD
6/8/2012
6/8/2017 MEDICINE
EMERGENCY
P4739
CANNON, BRETT H, MD
11/1/2012
11/1/2017 MEDICINE
N8081
CAO, CARLOS ERNESTO, MD
N8384
CARBAJAL, JOSE MARCOS, MD
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICAL SERVICES
EMERGENCY
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
4/20/2009 None
N/A
TX
ACTIVE
3/5/2013 None
N/A
TEMPLE
TX
ACTIVE
1/6/2010 None
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
10/12/2011 None
N/A
10/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
10/19/2012 None
N/A
3/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/15/2011 None
N/A
4/9/2010 None
N/A
10/21/2010 None
N/A
6/8/2012 None
N/A
11/1/2012 None
N/A
2/13/2011 None
N/A
1/3/2011 None
N/A
EL PASO
KILLEEN
OK
TX
TX
EMERGENCY
11/15/2010 11/15/2015 MEDICINE
EMERGENCY
1/3/2011
1/3/2016 MEDICINE
P5161
CARDON, CANDICE THERESA, MD
1/4/2013
N7237
CARLSON, TODD EVAN, MD
8/2/2010
N6832
CARNELL, JENNIFER, MD
7/1/2010
N6834
CARRIKER, CURTIS G, MD
7/1/2010
M3976
CHAKMAKIAN, VACHE, MD
4/9/2010
EMERGENCY
1/4/2018 MEDICINE
EMERGENCY
8/2/2015 MEDICINE
EMERGENCY
7/1/2015 MEDICINE
EMERGENCY
7/1/2015 MEDICINE
EMERGENCY
4/9/2015 MEDICINE
FAMILY PRACTICE
Page 43 of 301
Disciplinary
Status Date
TEMPLE
FORT SAM
HOUSTON
OKLAHOMA
CITY
PEDIATRIC
EMERGENCY
MEDICINE (EM)
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
CORPUS
CHRISTI
TX
ACTIVE
1/24/2013 None
N/A
RICHMOND
TX
ACTIVE
8/12/2010 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
7/12/2010 None
N/A
7/1/2010 None
N/A
ACTIVE
4/26/2010 None
N/A
BORGER
TX
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
CHANDLER, JENNIFER STOKEY,
EMERGENCY
N5613
MD
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
P3519
CHANG, MARY PEARL, MD
6/8/2012
6/8/2017 MEDICINE
EMERGENCY
P6353
CHANG, RICHARD RAY, MD
5/1/2013
5/1/2018 MEDICINE
CHARFEN, CHARLOTTE NEWMAN,
EMERGENCY
P1736
MD
1/2/2012
1/2/2017 MEDICINE
EMERGENCY
URGENT CARE
N6215
CHAVEZ-GELO, EDNA MELINA, MD
6/4/2010
6/4/2015 MEDICINE
MEDICINE
EMERGENCY
P5522
CHEN, AARON, MD
2/8/2013
2/8/2018 MEDICINE
EMERGENCY
P7412
CHEN, JERRY, DO
8/1/2013
8/1/2018 MEDICINE
EMERGENCY
P6356
CHENG, PANG, MD
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
N8283
CHIN, ERIC JOSEPH, MD
12/15/2010 12/15/2015 MEDICINE
EMERGENCY
P2107
CHOU, SHIH-CHIN, MD
2/10/2012
2/10/2017 MEDICINE
N6224
CHOW, YVONNE C, MD
P0025
CHRISTENSEN, HILARY, DO
N9441
CIARLO, JACQUE DIANE, DO
N4989
CLARKE, CLARENCE GEORGE, DO
P1980
N0705
CLARKE, JONATHAN ERIC, MD
COCHRAN, JEFFREY DWIGHT JR,
MD
N4990
COFFIE, LINCOLN G, MD
N3574
CONROY, STEVEN MICHAEL, DO
CONSTANTINE, MATTHEW
WAYNE, MD
P0365
P0820
COOLEY, CRAIG, MD
6/4/2010
6/15/2011
4/15/2011
2/5/2010
2/1/2012
8/29/2008
2/5/2010
8/21/2009
7/15/2011
8/26/2011
EMERGENCY
6/4/2015 MEDICINE
EMERGENCY
6/15/2016 MEDICINE
EMERGENCY
4/15/2016 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
EMERGENCY
2/1/2017 MEDICINE
EMERGENCY
8/29/2013 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
7/15/2016 MEDICINE
EMERGENCY
8/26/2016 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
LONGVIEW
TX
ACTIVE
4/16/2010 None
N/A
HOUSTON
TX
ACTIVE
6/25/2012 None
N/A
FT. WORTH
TX
ACTIVE
6/12/2013 None
N/A
KISSIMMEE
FL
1/16/2012 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
6/4/2010 None
N/A
DALLAS
TX
ACTIVE
2/18/2013 None
N/A
HOUSTON
TX
ACTIVE
8/16/2013 None
N/A
ACTIVE
5/3/2013 None
N/A
FT. SAM
HOUSTON
TX
ACTIVE
1/5/2011 None
N/A
FLUSHING
NY
ACTIVE
2/20/2012 None
N/A
6/4/2010 None
N/A
6/15/2011 None
N/A
4/15/2011 None
N/A
2/5/2010 None
N/A
2/8/2012 None
N/A
ACTIVE
LICENSE
ISSUED
9/26/2008 None
N/A
2/5/2010 None
N/A
SPORTS MEDICINE GENERAL PRACTICE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
EMERGENCY
MEDICINE
EMERGENCY
MEDICAL SERVICES
ACTIVE
TEMPLE
EMERGENCY
MEDICAL SERVICES
Page 44 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
AUSTIN
TX
ACTIVE
8/31/2009 None
N/A
DALLAS
TX
ACTIVE
7/20/2011 None
N/A
SAN ANTONIO TX
ACTIVE
8/31/2011 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
P7626
CORRIGAN, DEVLYN, DO
8/15/2013
8/15/2018 MEDICINE
EMERGENCY
N0708
COWAN, CRAIG BRUCE II, DO
8/29/2008
8/29/2013 MEDICINE
CRANDALL, ERIC BRINGHURST,
EMERGENCY
N2042
MD
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
N8636
CRISTIA, CRISTAL , MD
2/4/2011
2/4/2016 MEDICINE
EMERGENCY
P2844
CROSS, MATTHEW WELDON, MD
4/13/2012
4/13/2017 MEDICINE
EMERGENCY
N3586
CULLEN, SHAWN , MD
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
N6241
CYRUS, ARTHUR CLIVE, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
N2998
CZARNIK, ANN CLARICE , MD
5/29/2009
5/29/2014 MEDICINE
EMERGENCY
N8900
DADOUCH, HACHEM, MD
3/1/2011
3/1/2016 MEDICINE
EMERGENCY
N8901
DANG, HUNG HOANG, DO
3/1/2011
3/1/2016 MEDICINE
EMERGENCY
P1856
DANNA, JOSEPH RICHARD, MD
1/17/2012
1/17/2017 MEDICINE
DARHOWER, ADRIENNE MONIQUE,
EMERGENCY
N2462
MD
4/3/2009
4/3/2014 MEDICINE
EMERGENCY
N8902
DATES, CRAIG ALEXANDER, MD
3/1/2011
3/1/2016 MEDICINE
EMERGENCY
P2225
DAUM, ALLISON NICOLE, MD
3/1/2012
3/1/2017 MEDICINE
EMERGENCY
P0032
DAVID, HENRY W, MD
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
P7758
DE LOS SANTOS, DANIEL , MD
8/30/2013
8/30/2018 MEDICINE
DE OLIVEIRA, LUCIANA FONSECA,
EMERGENCY
N2054
MD
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
N2055
DEAN, LARA , MD
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
N6123
DEES, CHARLES DONALD, MD
6/4/2010
6/4/2015 MEDICINE
DELAUGHTER, JONETHAN PAUL,
EMERGENCY
N5647
DO
4/9/2010
4/9/2015 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
GENERAL PRACTICE MIDLAND
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
TX
ACTIVE
8/23/2013 None
N/A
TX
ACTIVE
10/8/2008 None
N/A
ACTIVE
LICENSE
ISSUED
2/26/2009 None
N/A
2/4/2011 None
N/A
SAN ANTONIO TX
ACTIVE
4/18/2012 None
N/A
TYLER
ACTIVE
LICENSE
ISSUED
8/27/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
6/5/2009 None
N/A
ACTIVE
3/7/2011 None
N/A
ACTIVE
3/17/2011 None
N/A
ACTIVE
2/6/2012 None
N/A
ACTIVE
4/15/2009 None
N/A
ACTIVE
4/8/2011 None
N/A
ACTIVE
LICENSE
ISSUED
3/8/2012 None
N/A
6/15/2011 None
N/A
TX
ACTIVE
9/10/2013 None
N/A
TX
ACTIVE
2/17/2009 None
N/A
ACTIVE
LICENSE
ISSUED
4/27/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
4/19/2010 None
N/A
TEMPLE
SAN ANTONIO TX
KILLEEN
TX
TX
INTERNAL MEDICINE
KILLEEN, TX
TX
INTERNAL MEDICINE
GRASONVILLE MD
URGENT CARE
MEDICINE
HOUSTON
Page 45 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANTONIO TX
DANVILLE
PA
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
F6568
DENNEY, TERESA SUSAN, MD
8/26/2011
8/26/2016 MEDICINE
EMERGENCY
N5013
DERESKA, PAUL STEPHEN , DO
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
P1452
DESANTIS, JAMES MICHAEL, MD
11/15/2011 11/15/2016 MEDICINE
EMERGENCY
N8089
DHARAMSI, FARID , MD
11/15/2010 11/15/2015 MEDICINE
EMERGENCY
N9692
DIAZ, CHRISTOPHER DAVID, MD
5/16/2011
5/16/2016 MEDICINE
EMERGENCY
P2229
DING, LIN, DO
3/1/2012
3/1/2017 MEDICINE
EMERGENCY
P3144
DIXIT, SANTOSH KUMAR, DO
5/15/2012
5/15/2017 MEDICINE
EMERGENCY
P7268
DOBKIN, DEAN, MD
7/15/2013
7/15/2018 MEDICINE
DOSHI, PRATIK BHARATKUMAR,
EMERGENCY
N1307
MD
10/10/2008 10/10/2013 MEDICINE
EMERGENCY
P1292
DUFFY, THARREN CHARLES, DO
11/4/2011
11/4/2016 MEDICINE
EMERGENCY
P5618
DUFRESNE, GARY WILLIAM, DO
3/1/2013
3/1/2018 MEDICINE
EMERGENCY
H2349
DUKE, SHARON NELSON, DO
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
N9847
DUNCAN, BRANNON CHARLES, MD
6/3/2011
6/3/2016 MEDICINE
EMERGENCY
N7417
DUNCAN, CORY EVAN, MD
8/16/2010
8/16/2015 MEDICINE
EMERGENCY
P0041
DUNCAN, YANA, DO
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
N6270
DUONG, CHUONG, DO
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
P7429
DWYER, PAUL RICHARD, MD
8/1/2013
8/1/2018 MEDICINE
EMERGENCY
N2480
DYMOTT, JEAN ANN, MD
4/3/2009
4/3/2014 MEDICINE
EMERGENCY
N6276
EGLY, JOSHUA ALEXANDER, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
P5176
EITTER, PATRICK THOMAS, MD
1/4/2013
1/4/2018 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
MISSOULA
CRITICAL CARE NEUROSURGERY
Registration
Status of
Practice
Texas
State
License
MT
Page 46 of 301
Disciplinary
Status Date
9/6/2011 None
N/A
2/5/2010 None
N/A
11/15/2011 None
N/A
DALLAS
TX
ACTIVE
12/2/2010 None
N/A
TYLER
TX
ACTIVE
6/15/2011 None
N/A
FLUSHING
NY
ACTIVE
3/23/2012 None
N/A
HOUSTON
TX
ACTIVE
5/21/2012 None
N/A
PHILADELPHIA PA
ACTIVE
7/18/2013 None
N/A
HOUSTON
TX
ACTIVE
1/13/2009 None
N/A
GRAND BLANC MI
ACTIVE
12/13/2011 None
N/A
SAN ANTONIO TX
ACTIVE
3/4/2013 None
N/A
SNEEDVILLE
TN
ACTIVE
11/16/2009 None
N/A
AUSTIN
TX
ACTIVE
6/17/2011 None
N/A
ARLINGTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/23/2010 None
N/A
6/15/2011 None
N/A
6/4/2010 None
N/A
8/12/2013 None
N/A
4/9/2009 None
N/A
6/4/2010 None
N/A
1/15/2013 None
N/A
FAMILY MEDICINE
AEROSPACE
MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
WYOMING
MI
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
License
Number
Physician Name
P7431
ELLIS, STEVEN LEE, DO
N9048
ELLIS, THOMAS WALLACE, MD
N6282
ELWELL, DANIEL MARK, DO
ENCARNACION, ORLANDO JOSE,
MD
ENTRIKEN, WILLIAM FRANCIS JR,
DO
N5038
P0047
P2232
EPPEL, KONRAD JOSEPH, MD
N3637
ESCOTT, MARK EDWARD , MD
N9366
FAIG, OFER, MD
N3638
FAIRLESS, JUSTIN WALTER, DO
N7616
FASINA, ABIOLA A, MD
FEDERICO, MASSIMO DOMENICO,
MD
P4441
N8783
N7256
FEDOR, PRESTON JOSEPH, MD
FERNANDEZ, MARIO BENJAMIN,
MD
P2440
FERONTI, CHARLES JAMES, DO
N7422
N5676
FISTER, COURTNEY, DO
FLAGGE, MICHELE CATHERINE,
MD
P5975
FLANAGAN, MARK NICHOLAS, DO
N8096
FOLAND, MARK JOSHUA, MD
N4412
FONTANE, EMILY, MD
N9052
FOSTER, PAUL ANDREW, DO
edicaid
edicaid
End Date
Designated)
EMERGENCY
8/1/2013
8/1/2018 MEDICINE
EMERGENCY
3/15/2011
3/15/2016 MEDICINE
EMERGENCY
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
3/1/2012
3/1/2017 MEDICINE
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
4/8/2011
4/8/2016 MEDICINE
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
9/1/2010
9/1/2015 MEDICINE
EMERGENCY
9/17/2012
9/17/2017 MEDICINE
EMERGENCY
2/15/2011
2/15/2016 MEDICINE
EMERGENCY
8/2/2010
8/2/2015 MEDICINE
EMERGENCY
3/15/2012
3/15/2017 MEDICINE
EMERGENCY
8/16/2010
8/16/2015 MEDICINE
EMERGENCY
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
4/1/2013
4/1/2018 MEDICINE
EMERGENCY
11/15/2010 11/15/2015 MEDICINE
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
3/15/2011
3/15/2016 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
EL PASO
TX
THE
WOODLANDS TX
EMERGENCY
MEDICINE
EMERGENCY
MEDICAL SERVICES
Page 47 of 301
Disciplinary
Status Date
8/6/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
3/18/2011 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
6/15/2011 None
N/A
KLAMATH
FALLS
OR
ACTIVE
3/28/2012 None
N/A
HERSHEY
PA
ACTIVE
11/20/2009 None
N/A
ACTIVE
4/15/2011 None
N/A
ACTIVE
8/31/2009 None
N/A
ACTIVE
9/8/2010 None
N/A
9/19/2012 None
N/A
2/15/2011 None
N/A
ACTIVE
8/5/2010 None
N/A
SAN ANTONIO TX
ARLINGTON
HEIGHTS
IL
ACTIVE
4/19/2012 None
N/A
ACTIVE
8/19/2010 None
N/A
DALLAS
ACTIVE
LICENSE
ISSUED
4/20/2010 None
N/A
4/1/2013 None
N/A
ACTIVE
12/6/2010 None
N/A
FORT HOOD
PEDIATRICS
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
12/15/2009 None
N/A
AUSTIN
TX
ACTIVE
4/6/2011 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
P2443
FOWLER, MICHELE MARIE, DO
3/15/2012
3/15/2017 MEDICINE
EMERGENCY
N9855
FRANCIS, TODD LLEWELLYN, DO
6/3/2011
6/3/2016 MEDICINE
EMERGENCY
N8785
FRAYSER, SHELLY FRANCES, MD
2/15/2011
2/15/2016 MEDICINE
EMERGENCY
P1303
FRYBARGER, JAMES ROBERT, MD
11/4/2011
11/4/2016 MEDICINE
EMERGENCY
N3655
GAGRICA, MELISA HELENE, MD
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
P4445
GALL, JOHN ANTHONY, MD
9/17/2012
9/17/2017 MEDICINE
GAMBAROTA, MARCI CATHERINE,
EMERGENCY
P7766
MD
8/30/2013
8/30/2018 MEDICINE
EMERGENCY
N9056
GARCIA, BRIANA, MD
3/15/2011
3/15/2016 MEDICINE
EMERGENCY
P2242
GARDNER, KIMBERLY RENEE, MD
3/1/2012
3/1/2017 MEDICINE
EMERGENCY
N5069
GARRETT, JOHN SIGEL, MD
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
N7618
GEMMILL, JENNIFER MARIE, MD
9/1/2010
9/1/2015 MEDICINE
EMERGENCY
P0052
GENINATTI, MARILYN RAE, MD
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
P3154
GENTILE, MARK PATRICK, MD
5/15/2012
5/15/2017 MEDICINE
EMERGENCY
P1999
GERARD, JODY, MD
2/1/2012
2/1/2017 MEDICINE
EMERGENCY
P4957
GLASSMAN, THEODORE, MD
11/30/2012 11/30/2017 MEDICINE
EMERGENCY
P6620
GLICK, JONATHAN MICHAEL, MD
5/15/2013
5/15/2018 MEDICINE
EMERGENCY
P7445
GODFREY, BENJAMIN ROBERT, DO
8/1/2013
8/1/2018 MEDICINE
EMERGENCY
P3158
GOLDBERG, SCOTT, MD
5/15/2012
5/15/2017 MEDICINE
EMERGENCY
P1644
GOLLA, PRADEEP, DO
12/15/2011 12/15/2016 MEDICINE
EMERGENCY
J8252
GOYAL, LALIT, MD
6/1/2012
6/1/2017 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
CORPUS
CHRISTI
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
4/6/2012 None
N/A
6/17/2011 None
N/A
2/15/2011 None
N/A
TX
ACTIVE
11/10/2011 None
N/A
DALLAS
TX
ACTIVE
9/14/2009 None
N/A
COLUMBUS
IN
ACTIVE
LICENSE
ISSUED
11/21/2012 None
N/A
8/30/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/8/2011 None
N/A
3/1/2012 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
11/1/2010 None
N/A
6/15/2011 None
N/A
SAN ANTONIO TX
ACTIVE
5/22/2012 None
N/A
SAN ANTONIO TX
ACTIVE
2/13/2012 None
N/A
ACTIVE
12/10/2012 None
N/A
MIDDLETOWN CT
ACTIVE
5/21/2013 None
N/A
HOUSTON
TX
ACTIVE
8/6/2013 None
N/A
DALLAS
OLYMPIA
FIELDS
TX
ACTIVE
6/22/2012 None
N/A
IL
ACTIVE
12/19/2011 None
N/A
DAYTON
OH
ACTIVE
6/11/2012 None
N/A
EL PASO
TEMPLE
Page 48 of 301
Disciplinary
Status Date
HOUSTON
PALLIATIVE
MEDICINE
EMERGENCY
MEDICAL SERVICES
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
N9558
GOZHANSKY, DAN, MD
5/2/2011
5/2/2016 MEDICINE
GRANDSTAFF, PHILLIP MATTHEW,
EMERGENCY
P2252
MD
3/1/2012
3/1/2017 MEDICINE
EMERGENCY
EMERGENCY
N6880
GREEN, WALTER LOUIS, MD
7/1/2010
7/1/2015 MEDICINE
MEDICAL SERVICES
MEDICAL
TOXICOLOGY
EMERGENCY
(EMERGENCY
P4572
GREENE, SPENCER COREY, MD
10/1/2012
10/1/2017 MEDICINE
MEDICINE)
GREENGART, DAVID JONATHAN,
EMERGENCY
N5083
MD
2/5/2010
2/5/2015 MEDICINE
GREENWOOD, NATHANIEL
EMERGENCY
EMERGENCY
P2863
VROMAN, DO
4/13/2012
4/13/2017 MEDICINE
MEDICAL SERVICES
EMERGENCY
P1759
GREGORY, JANET, DO
1/2/2012
1/2/2017 MEDICINE
EMERGENCY
N4440
GREGORY, LINDA , DO
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
P6172
GUESS, AARON ALAN, DO
4/12/2013
4/12/2018 MEDICINE
EMERGENCY
P3163
GUST, SHANNON KATHLEEN, MD
5/15/2012
5/15/2017 MEDICINE
EMERGENCY
P2452
GUTIERREZ, JOSE ARMANDO, MD
3/15/2012
3/15/2017 MEDICINE
EMERGENCY
N3713
HAMAKER, JUSTIN CHARLES, MD
8/21/2009
8/21/2014 MEDICINE
N5095
HAMID, STACY ELISE, MD
2/5/2010
L3675
HAMILTON, CARLTON
CARMICHAEL II, MD
N8010
HAMILTON, RENEE CHRISTINE, MD
P5373
HANRAHAN, ROBERT, MD
2/1/2013
N9563
HANSCOM, DAVID RAMSEY, DO
5/2/2011
N8516
HANSEN, JENNIFER, DO
4/13/2012
10/29/2010
1/18/2011
EMERGENCY
2/5/2015 MEDICINE
Practice City
AUSTIN
ALLEN
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
ACTIVE
5/20/2011 None
N/A
ACTIVE
3/9/2012 None
N/A
ACTIVE
7/13/2010 None
N/A
ACTIVE
LICENSE
ISSUED
SEE
PREVIOUS
10/18/2012 ORDER
11/16/2012
2/5/2010 None
N/A
TX
ACTIVE
4/25/2012 None
N/A
HOUSTON
TX
ACTIVE
2/2/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
11/13/2009 None
N/A
4/12/2013 None
N/A
ROWLETT
TX
ACTIVE
5/29/2012 None
N/A
DALLAS
TX
ACTIVE
3/23/2012 None
N/A
TEMPLE
TX
ACTIVE
8/26/2009 None
UNDER
BOARD
2/5/2010 ORDER
N/A
4/13/2012 None
N/A
10/29/2010 None
N/A
CLEARWATER FL
Page 49 of 301
Disciplinary
Status Date
ABILENE
ANESTHESIOLOGY
EMERGENCY
4/13/2017 MEDICINE
EMERGENCY
10/29/2015 MEDICINE
EMERGENCY
2/1/2018 MEDICINE
EMERGENCY
5/2/2016 MEDICINE
EMERGENCY
1/18/2016 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
12/7/2009
KALAMAZOO
MADISON
HEIGHTS
MI
ACTIVE
2/15/2013 None
N/A
MI
ACTIVE
5/6/2011 None
N/A
DALLAS
TX
ACTIVE
1/27/2011 None
N/A
License
Number
Physician Name
N2104
HARJAI, JOGESH KUMAR, MD
N2105
HARO, LUIS HUMBERTO, MD
N4453
HARRIS, JOHN JASON, MD
P3634
HARRIS, RYAN JED, MD
P0729
HARRISON, MATTHEW LEE, DO
P7119
HARROW, JEFFREY ALAN, MD
P6414
HEARD, DENNIS J II, DO
P7279
HEIBERGER, BRANDON JOE, MD
N9375
HELMAN, JOSHUA BENNETT, MD
N8791
N3080
HEMMERT, JONATHAN WYNN, MD
HENNESSY, ROBERTO VICTOR,
MD
N9873
HENRY, SHELISE MICHELE, MD
N9222
HENSLEY, JUSTIN PAUL, MD
P4961
HILL, GUYON JAMES, MD
N8519
HILLS, TINA , DO
N7280
HILMI, JOHN OMAR, MD
P0982
HILTON, LEVI JEFFERSON, MD
P4657
HITCHCOCK, ROBERT JOHN, MD
P1082
HODGE, SCOTT DAVID, MD
P2673
HOENE, ANDREW JOHN, MD
edicaid
edicaid
End Date
Designated)
EMERGENCY
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
6/15/2012
6/15/2017 MEDICINE
EMERGENCY
8/15/2011
8/15/2016 MEDICINE
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
EMERGENCY
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
7/15/2013
7/15/2018 MEDICINE
EMERGENCY
4/8/2011
4/8/2016 MEDICINE
EMERGENCY
2/15/2011
2/15/2016 MEDICINE
EMERGENCY
5/29/2009
5/29/2014 MEDICINE
EMERGENCY
6/3/2011
6/3/2016 MEDICINE
EMERGENCY
4/1/2011
4/1/2016 MEDICINE
EMERGENCY
11/30/2012 11/30/2017 MEDICINE
EMERGENCY
1/18/2011
1/18/2016 MEDICINE
EMERGENCY
8/2/2010
8/2/2015 MEDICINE
EMERGENCY
9/15/2011
9/15/2016 MEDICINE
EMERGENCY
10/15/2012 10/15/2017 MEDICINE
EMERGENCY
10/3/2011
10/3/2016 MEDICINE
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICAL SERVICES
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
2/24/2009 None
N/A
TYLER
TX
ACTIVE
2/17/2009 None
N/A
TEXARKANA
CAMP
LEJEUNE
TX
ACTIVE
11/24/2009 None
N/A
NC
ACTIVE
LICENSE
ISSUED
6/21/2012 None
N/A
8/15/2011 None
N/A
TX
ACTIVE
8/14/2013 None
N/A
FORT WORTH TX
ACTIVE
5/8/2013 None
N/A
NASSAU BAY
ACTIVE
7/17/2013 None
N/A
ACTIVE
LICENSE
ISSUED
4/21/2011 None
N/A
2/15/2011 None
N/A
SAN ANTONIO TX
ACTIVE
6/19/2009 None
N/A
ROCHELLE
CORPUS
CHRISTI
FORT SAM
HOUSTON
IL
ACTIVE
6/21/2011 None
N/A
TX
ACTIVE
4/6/2011 None
N/A
TX
ACTIVE
12/4/2012 None
N/A
FT HOOD
WICHITA
FALLS
TX
ACTIVE
2/2/2011 None
N/A
TX
ACTIVE
8/5/2010 None
N/A
DALLAS
TX
ACTIVE
9/26/2011 None
N/A
ACTIVE
10/22/2012 None
N/A
ACTIVE
10/24/2011 None
N/A
ACTIVE
4/11/2012 None
N/A
MCKINNEY
EMERGENCY
MEDICAL SERVICES
Page 50 of 301
Disciplinary
Status Date
CONROE
GENERAL PRACTICE
URGENT CARE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
AUSTIN
TX
TX
License
Number
P1764
Physician Name
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
1/2/2012
1/2/2017 MEDICINE
EMERGENCY
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
URGENT CARE
8/1/2013
8/1/2018 MEDICINE
MEDICINE
EMERGENCY
7/1/2011
7/1/2016 MEDICINE
EMERGENCY
5/2/2011
5/2/2016 MEDICINE
EMERGENCY
8/26/2011
8/26/2016 MEDICINE
EMERGENCY
6/1/2012
6/1/2017 MEDICINE
EMERGENCY
8/1/2013
8/1/2018 MEDICINE
EMERGENCY
9/15/2010
9/15/2015 MEDICINE
EMERGENCY
3/1/2013
3/1/2018 MEDICINE
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
P6419
HOFFMAN, KEVIN LEE, MD
HOLLINGWORTH, DANIELLE
MARIE, MD
P7465
HONG, ROBERT, MD
P0228
HONTZ, BLAIR, DO
N9567
HORN, BRETT W, MD
P0835
HORRALL, SHAWN DANIEL, MD
P3350
HOUGH, SCOTT MATTHEW, MD
P7466
HOUSER, JOSHUA L, MD
N7705
HOWARD, TANYA DAYELL, MD
P5645
HOWELL, AMBER , MD
N5115
HUBMER, THOMAS CARL, DO
N5737
HURST, DAVID GREIG , MD
N3745
HUSAIN, TAMEEM SIRAJ, DO
8/21/2009
P6189
4/12/2013
P4966
HWANG, YOO JOO, DO
IFAFORE, ADEBOLA TEMITOPE,
MD
P7129
IRELAND, RHIANA, MD
P7787
IYANAGA, MASAYUKI, MD
8/30/2013
EMERGENCY
4/9/2015 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
4/12/2018 MEDICINE
EMERGENCY
11/30/2017 MEDICINE
EMERGENCY
7/1/2018 MEDICINE
EMERGENCY
8/30/2018 MEDICINE
P2125
JACKSON, DANIELLE, MD
2/10/2012
EMERGENCY
2/10/2017 MEDICINE
L6075
JACKSON, MARK R, MD
4/9/2010
11/30/2012
7/1/2013
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
1/4/2012 None
N/A
ACTIVE
5/24/2013 None
N/A
ACTIVE
8/5/2013 None
N/A
EL PASO
TX
ACTIVE
7/27/2011 None
N/A
AMARILLO
TX
ACTIVE
5/5/2011 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
8/31/2011 None
N/A
6/1/2012 None
N/A
TEMPLE
WICHITA
FALLS
TX
ACTIVE
8/5/2013 None
N/A
TX
ACTIVE
10/15/2010 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
4/10/2013 None
N/A
N/A
WACO
TX
ACTIVE
2/5/2010 None
SEE
PREVIOUS
4/16/2010 ORDER
AUSTIN
TX
ACTIVE
9/18/2009 None
N/A
ACTIVE
4/22/2013 None
N/A
ACTIVE
12/12/2012 None
N/A
7/17/2013 None
N/A
8/30/2013 None
SEE
PREVIOUS
2/14/2012 ORDER
N/A
EMERGENCY
12/15/2010 12/15/2015 MEDICINE
Page 51 of 301
LONGVIEW
TX
EL PASO
TX
AUSTIN
TX
TOOELE
UT
ACTIVE
LICENSE
ISSUED
ACTIVE
TEXAS
LICENSE
ISSUED
12/15/2010 None
4/12/2010
2/13/2012
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
N8407
JACKSON-VANCE, SARA ANN, MD
1/3/2011
1/3/2016 MEDICINE
EMERGENCY
N0855
JACOBSON, BRADLEY ELLIS, MD
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
N2578
JACOBSON, GREGORY H, MD
4/3/2009
4/3/2014 MEDICINE
EMERGENCY
P5388
JENKINS, JOSEPH RAY, MD
2/1/2013
2/1/2018 MEDICINE
EMERGENCY
P7133
JENSEN, CLAIRE STEWART, MD
7/1/2013
7/1/2018 MEDICINE
EMERGENCY
P7134
JIMENEZ, HAROLD ESTEBAN, MD
7/1/2013
7/1/2018 MEDICINE
EMERGENCY
P2691
JOE, TIFFANY DAISY, MD
4/2/2012
4/2/2017 MEDICINE
EMERGENCY
N9076
JOHNSON, DOMINIC ALASTAIR, MD
3/15/2011
3/15/2016 MEDICINE
EMERGENCY
N6394
JOHNSON, JEREMY NELSON , DO
6/4/2010
6/4/2015 MEDICINE
JOHNSON, RICHISA LESSICA
EMERGENCY
N6395
SAMELAJOY, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
N3767
JONES, BENJAMIN CLIFFORD , MD
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
N4500
JONES, TIMOTHY ROBERT, MD
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
P2878
JORGENSEN, TYLER SCOTT, MD
4/13/2012
4/13/2017 MEDICINE
EMERGENCY
N3107
JUNTUNEN, JAMIE M, MD
5/29/2009
5/29/2014 MEDICINE
EMERGENCY
N9077
KAGALWALLA, ABID AMIR, MD
3/15/2011
3/15/2016 MEDICINE
EMERGENCY
P2272
KALCICH, MICHAEL, MD
3/1/2012
3/1/2017 MEDICINE
EMERGENCY
N5755
KANDEL, KRISTA JAHNKE, MD
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
N8527
KARR, NICHOLAS, MD
1/18/2011
1/18/2016 MEDICINE
EMERGENCY
N8020
KAY, LAURA SUE, MD
10/29/2010 10/29/2015 MEDICINE
EMERGENCY
P3367
KEEPERMAN, JACOB BRIAN, MD
6/1/2012
6/1/2017 MEDICINE
Secondary Specialty
(Self-Designated)
PALLIATIVE
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Page 52 of 301
Disciplinary
Status Date
1/3/2011 None
N/A
ACTIVE
9/5/2008 None
N/A
ACTIVE
4/15/2009 None
N/A
ABILENE
TX
ACTIVE
2/4/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
7/8/2013 None
N/A
7/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/25/2012 None
N/A
3/15/2011 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
SAN ANTONIO TX
CORPUS
CHRISTI
TX
ACTIVE
9/25/2009 None
N/A
ACTIVE
11/16/2009 None
N/A
ROUND ROCK TX
ACTIVE
4/17/2012 None
N/A
SAN ANTONIO TX
ACTIVE
6/29/2009 None
N/A
SAN MARCOS TX
ACTIVE
4/1/2011 None
N/A
ACTIVE
4/2/2012 None
N/A
SAN ANTONIO TX
ACTIVE
4/20/2010 None
N/A
DETROIT
ACTIVE
LICENSE
ISSUED
1/24/2011 None
N/A
10/29/2010 None
N/A
6/4/2012 None
N/A
SAN MARCOS TX
EMERGENCY
MEDICAL SERVICES
Registration
Status Date
Disciplinary
Status of
Texas
License
SAINT LOUIS
MI
MO
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
EMERGENCY
7/15/2010
7/15/2015 MEDICINE
EMERGENCY
5/1/2012
5/1/2017 MEDICINE
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
EMERGENCY
4/1/2011
4/1/2016 MEDICINE
EMERGENCY
4/1/2011
4/1/2016 MEDICINE
N7118
KENNEDY, JARED , MD
P3015
KERNAN, LEAH KATHYANN, DO
P7135
KERNS, JOHNATHON SCOTT, DO
N9243
KHAN, SUHAIL RAHMAN, MD
N9247
KIM, DANIEL JIN-YOUNG, MD
N7709
KIM, STEPHEN, MD
9/15/2010
N3116
KING, FELICIA LASHAUN , MD
5/29/2009
N9580
KINZLER, DAMIEN WEBB, DO
5/2/2011
P2705
KLECKNER, KENNETH, MD
4/2/2012
N5783
KLESNEY, DEANNA MARIE, MD
4/9/2010
P6667
KUDRATH, ABDULLA , MD
5/15/2013
P7660
LABORDE, CATHERINE, MD
8/15/2013
N7445
LAGISETTY, JYOTHI RAMA, MD
8/16/2010
P6854
LAIRD, JOSHUA CODY, MD
P0991
LAMBERT, JERRY V JR, MD
LANGAN, CHRISTOPHER JOHN,
MD
LAPEROUSE, LAMBERT MARK JR,
MD
9/15/2011
LAROCHE, LAUREN ASHLEIGH, MD
LAWSON, NICHOLETTE MICHELLE,
MD
2/10/2012
N3812
N6447
P2138
N9088
6/3/2013
8/21/2009
6/4/2010
3/15/2011
EMERGENCY
9/15/2015 MEDICINE
EMERGENCY
5/29/2014 MEDICINE
EMERGENCY
5/2/2016 MEDICINE
EMERGENCY
4/2/2017 MEDICINE
EMERGENCY
4/9/2015 MEDICINE
EMERGENCY
5/15/2018 MEDICINE
EMERGENCY
8/15/2018 MEDICINE
EMERGENCY
8/16/2015 MEDICINE
EMERGENCY
6/3/2018 MEDICINE
Secondary Specialty
(Self-Designated)
URGENT CARE
MEDICINE
PEDIATRIC EMER
MED (EM)
EMERGENCY
9/15/2016 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
6/4/2015 MEDICINE
EMERGENCY
2/10/2017 MEDICINE
EMERGENCY
3/15/2016 MEDICINE
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/15/2010 None
N/A
5/1/2012 None
N/A
7/1/2013 None
N/A
PEORIA
IL
ACTIVE
4/21/2011 None
N/A
DALLAS
TX
ACTIVE
N/A
GALVESTON
TX
ACTIVE
4/8/2011 None
UNDER
BOARD
9/20/2010 ORDER
HOUSTON
TX
ACTIVE
6/3/2009 None
N/A
PHILADELPHIA PA
ACTIVE
5/25/2011 None
N/A
PHILADELPHIA PA
ACTIVE
4/17/2012 None
N/A
FT HOOD
TX
ACTIVE
4/28/2010 None
N/A
FORT WORTH TX
ACTIVE
5/22/2013 None
N/A
ACTIVE
8/19/2013 None
N/A
8/19/2010 None
N/A
6/6/2013 None
N/A
12/14/2011 None
N/A
8/27/2009 None
N/A
6/4/2010 None
N/A
2/10/2012 None
N/A
3/15/2011 None
N/A
HOUSTON
TX
ACTIVE
HOUSTON
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
HOUSTON
Page 53 of 301
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
9/9/2010
License
Number
Physician Name
P2887
LE, MINH MAN, MD
P7795
LEATHAM, AUNA OTTS, MD
P5832
LEE, FAYE, MD
N4547
LEE, FRANK MICHAEL, MD
P5202
LEE, JANA, MD
P0847
LEE, SANG HYUN, MD
P2480
LENERT-WILLIAMS, CARMELL, MD
P4671
LEWIS, RYAN LEIGHTON, MD
N2173
LI, MORGAN KUANG-TSU, MD
P7148
LIM, DAVID TAO-WAY, DO
N3839
LINDSAY, JEROME ALLEN II, MD
P3378
LINGAN, CHRISTOPHER C, MD
P0625
LIPPMANN, MELANIE JILL, MD
P0084
LIZARDI, PABLO L, MD
N9731
LOCASCIO, EDWARD JOHN, MD
N8317
LOPEZ, JOSUE EDWARD, MD
N2177
LOYD, JEFFERSON CARL, DO
P6022
LUCAS, MIKAEL, MD
N7833
LUMBRERAS, CHRISTINA B, MD
P5548
LUNSFORD, JEROD, MD
edicaid
edicaid
End Date
Designated)
EMERGENCY
4/13/2012
4/13/2017 MEDICINE
EMERGENCY
8/30/2013
8/30/2018 MEDICINE
EMERGENCY
3/15/2013
3/15/2018 MEDICINE
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
1/4/2013
1/4/2018 MEDICINE
EMERGENCY
8/26/2011
8/26/2016 MEDICINE
EMERGENCY
3/15/2012
3/15/2017 MEDICINE
EMERGENCY
10/15/2012 10/15/2017 MEDICINE
EMERGENCY
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
6/1/2012
6/1/2017 MEDICINE
EMERGENCY
8/1/2011
8/1/2016 MEDICINE
EMERGENCY
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
5/16/2011
5/16/2016 MEDICINE
EMERGENCY
12/15/2010 12/15/2015 MEDICINE
EMERGENCY
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
4/1/2013
4/1/2018 MEDICINE
EMERGENCY
10/1/2010
10/1/2015 MEDICINE
EMERGENCY
2/8/2013
2/8/2018 MEDICINE
Secondary Specialty
(Self-Designated)
URGENT CARE
MEDICINE
EMERGENCY
MEDICAL SERVICES
EMERGENCY
MEDICAL SERVICES
Practice City
WINTER
HAVEN
Registration
Status of
Practice
Texas
State
License
FL
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
4/16/2012 None
N/A
8/30/2013 None
N/A
ACTIVE
4/24/2013 None
N/A
AUSTIN
TX
ACTIVE
11/18/2009 None
N/A
GLENDALE
AZ
ACTIVE
1/9/2013 None
N/A
HOUSTON
TX
ACTIVE
9/2/2011 None
N/A
SHREVEPORT LA
ACTIVE
4/2/2012 None
N/A
LUBBOCK
TX
ACTIVE
10/19/2012 None
N/A
AUSTIN
TX
ACTIVE
2/25/2009 None
N/A
BURNET
TX
ACTIVE
7/4/2013 None
N/A
DENISON
TX
ACTIVE
LICENSE
ISSUED
9/10/2009 None
N/A
6/1/2012 None
N/A
8/9/2011 None
N/A
ACTIVE
LICENSE
ISSUED
6/20/2011 None
N/A
5/16/2011 None
N/A
ACTIVE
1/20/2011 None
N/A
ACTIVE
1/22/2010 None
N/A
DALLAS
TX
SAN ANTONIO TX
EL PASO
TX
OTHER SPECIALTY
Page 54 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
KATY
AMARILLO
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
4/3/2013 None
N/A
10/1/2010 None
N/A
ACTIVE
2/18/2013 None
N/A
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
P0629
MADAIN, SAFI B, DO
8/1/2011
8/1/2016 MEDICINE
EMERGENCY
P5411
MADHANI, NEAL BHAGWANJI, MD
2/1/2013
2/1/2018 MEDICINE
MALYA, ROHITH RAMACHANDRA,
EMERGENCY
P0089
MD
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
N3162
MANN, MICHAEL THOMAS, MD
5/29/2009
5/29/2014 MEDICINE
EMERGENCY
P6865
MAPES, KENNETH LEROY, MD
6/3/2013
6/3/2018 MEDICINE
MARRIOTT, KENNETH ARMISTICE
EMERGENCY
N8121
III, MD
11/15/2010 11/15/2015 MEDICINE
EMERGENCY
P7806
MARSHALL, LINDSAY ANNE, DO
8/30/2013
8/30/2018 MEDICINE
EMERGENCY
N3868
MARSILLO, KRISTY MARIE , DO
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
P2296
MARTIN, AMY RUTH, MD
3/1/2012
3/1/2017 MEDICINE
EMERGENCY
N9739
MARTIN, JASON MICHAEL, MD
5/16/2011
5/16/2016 MEDICINE
EMERGENCY
P5418
MARTINEZ, JOSE LUIS JR, MD
2/1/2013
2/1/2018 MEDICINE
EMERGENCY
N5842
MARTINEZ, ROBERT ERIC, MD
4/9/2010
4/9/2015 MEDICINE
MAVINKURVE, GAURAV GAJANAN,
EMERGENCY
N8685
MD
2/4/2011
2/4/2016 MEDICINE
EMERGENCY
P7504
MAYOR, JOEY DAVID OSCAR, MD
8/1/2013
8/1/2018 MEDICINE
EMERGENCY
N8123
MCCREARY, REAGANN R, DO
11/15/2010 11/15/2015 MEDICINE
PEDIATRICS
MCWILLIAMS, JEFFREY GRANT
EMERGENCY
N7143
SR, MD
7/15/2010
7/15/2015 MEDICINE
EMERGENCY
N7462
MEDLEY, DYLAN BLUE, MD
8/16/2010
8/16/2015 MEDICINE
EMERGENCY
P4786
MEHTA, AMIT MAYUR, MD
11/1/2012
11/1/2017 MEDICINE
EMERGENCY
P6222
MELTON, COLT LESLEY, MD
4/12/2013
4/12/2018 MEDICINE
EMERGENCY
P6680
MENNITE, BRIDGIT, MD
5/15/2013
5/15/2018 MEDICINE
Page 55 of 301
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
Practice City
BATON
ROUGE
LA
ACTIVE
8/3/2011 None
N/A
PITTSBURGH
PA
ACTIVE
LICENSE
ISSUED
2/5/2013 None
N/A
6/15/2011 None
N/A
AUSTIN
TX
ACTIVE
6/16/2009 None
N/A
GENOA
LACKLAND
AFB
OH
ACTIVE
6/19/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
11/22/2010 None
N/A
8/30/2013 None
N/A
ACTIVE
8/28/2009 None
N/A
ACTIVE
3/15/2012 None
N/A
AUSTIN
TX
KILLEEN
TX
ACTIVE
5/24/2011 None
N/A
HUMBLE
TX
ACTIVE
2/15/2013 None
N/A
EL PASO
TX
CHATTANOOG
A
TN
ACTIVE
5/3/2010 None
N/A
2/11/2011 None
N/A
8/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
12/10/2010 None
N/A
LONGVIEW
TX
ACTIVE
7/20/2010 None
N/A
TEMPLE
TX
ACTIVE
8/26/2010 None
N/A
HOUSTON
TX
STEPHENVILL
E
TX
ACTIVE
11/27/2012 None
N/A
ACTIVE
4/22/2013 None
N/A
MIDDLETOWN CT
ACTIVE
5/21/2013 None
N/A
License
Number
Physician Name
N4584
MENON, ANIL SAMOILENKO, MD
P1362
METZ, RACHEL LYNN, MD
P7512
MICHAUD, ROBERT JEROME, MD
N7146
MILLER, GREGG AARON, MD
P0444
MILLER, JOSHUA PAUL SR, MD
N9388
MILLER, KEEGAN VERN, DO
P2735
MIRZA, UMARFAROOK JAVED, DO
N0991
N1782
MODI, PRACHI MAHENDRA, MD
MONTOYA, ALBERTO EDUARDO,
MD
N8426
MOORE, ROBERT KEITH JR, MD
N5263
MORRIS, JUSTIN P, DO
edicaid
edicaid
End Date
Designated)
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
11/4/2011
11/4/2016 MEDICINE
EMERGENCY
8/1/2013
8/1/2018 MEDICINE
EMERGENCY
7/15/2010
7/15/2015 MEDICINE
EMERGENCY
7/15/2011
7/15/2016 MEDICINE
EMERGENCY
4/8/2011
4/8/2016 MEDICINE
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
EMERGENCY
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
12/12/2008 12/12/2013 MEDICINE
EMERGENCY
1/3/2011
1/3/2016 MEDICINE
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
N6510
MORRISSEY, RYAN PATRICK, MD
6/4/2010
6/4/2015
N9391
MOUSTAFA, MOUSTAFA H, MD
4/8/2011
4/8/2016
N7642
MOWER, MARK WILLIAM, MD
9/1/2010
9/1/2015
P3654
MURPHY, ANDREW CHARLES, MD
6/15/2012
6/15/2017
N2353
MYERS, DERRICK MARLIN, MD
4/3/2009
4/3/2014
N8048
NAGAVI, AMIR SEAN, MD
10/29/2010 10/29/2015
N8130
NARANG, ASHISH, DO
11/15/2010 11/15/2015
N4613
NEFF, JUSTIN MICHAEL, MD
11/6/2009
11/6/2014
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
STANFORD
CA
ACTIVE
11/16/2009 None
N/A
URGENT CARE
MEDICINE
HOUSTON
TX
ACTIVE
11/10/2011 None
N/A
FAMILY MEDICINE
SAN ANTONIO TX
ACTIVE
8/6/2013 None
N/A
LOS ANGELES CA
FORT SAM
HOUSTON
TX
ACTIVE
7/26/2010 None
N/A
ACTIVE
7/20/2011 None
N/A
FORT WORTH TX
ACTIVE
4/19/2011 None
N/A
BRONX
NY
ACTIVE
4/3/2012 None
N/A
AUSTIN
TX
ACTIVE
9/9/2008 None
N/A
ITHACA
CORPUS
CHRISTI
NY
ACTIVE
2/12/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
1/7/2011 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
FAMILY MEDICINE
MEDICAL
TOXICOLOGY
(EMERGENCY
MEDICINE)
LICENSE
ISSUED
AMARILLO
TX
ACTIVE
4/18/2011 None
N/A
TEMPLE
TX
ACTIVE
10/8/2010 None
N/A
DALLAS
TX
ACTIVE
6/21/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
5/22/2009 None
N/A
10/29/2010 None
N/A
ACTIVE
12/9/2010 None
N/A
ACTIVE
11/16/2009 None
N/A
URGENT CARE
MEDICINE
DALLAS
Page 56 of 301
TX
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
N9922
NEILSBERG, JASON RYAN, DO
6/3/2011
6/3/2016 MEDICINE
EMERGENCY
N6533
NESSELROADE, RYAN DAVID, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
N6534
NGO, VINH, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
P7821
NGUYEN, MICHAEL VAN, MD
8/30/2013
8/30/2018 MEDICINE
EMERGENCY
N8131
NGUYEN, PHUC HONG, DO
11/15/2010 11/15/2015 MEDICINE
EMERGENCY
P4794
NGUYEN, TUAN ANH NGOC, MD
11/1/2012
11/1/2017 MEDICINE
EMERGENCY
P2044
NICHOLS, PATRICK MARSHALL, DO
2/1/2012
2/1/2017 MEDICINE
EMERGENCY
P3656
NIETO, ROMAN JR, MD
6/15/2012
6/15/2017 MEDICINE
EMERGENCY
P0774
NOFZIGER, ADAM VON, MD
8/15/2011
8/15/2016 MEDICINE
EMERGENCY
N8132
NORTHEIM, JUSTIN R, DO
11/15/2010 11/15/2015 MEDICINE
NOYA, ANTHONY ARMANDO
EMERGENCY
P4795
DENIS, MD
11/1/2012
11/1/2017 MEDICINE
EMERGENCY
P2502
OBERG, ERIK DONALD, MD
3/15/2012
3/15/2017 MEDICINE
EMERGENCY
P2747
OBIE, OGADINMA IJEOMA, MD
4/2/2012
4/2/2017 MEDICINE
EMERGENCY
P5295
O'DEA, COLIN MAGNUSON, MD
1/15/2013
1/15/2018 MEDICINE
EMERGENCY
P5113
ODEDRA, RANDHIRJI P, MD
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
P5113
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
P5113
12/17/2012 12/17/2017 MEDICINE
EMERGENCY
P7683
ODOM, GEOFFREY LYLE, MD
8/15/2013
8/15/2018 MEDICINE
EMERGENCY
N1404
OFORDEME, KENECHUKWU , MD
10/10/2008 10/10/2013 MEDICINE
EMERGENCY
N7154
OKECHUKWU, CHRISTOPHER , MD
7/15/2010
7/15/2015 MEDICINE
Secondary Specialty
(Self-Designated)
FAMILY MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
9/9/2013 None
N/A
IRVING
TX
ACTIVE
12/9/2010 None
N/A
RICHMOND
TX
ACTIVE
11/5/2012 None
N/A
TX
ACTIVE
2/7/2012 None
N/A
6/21/2012 None
N/A
8/15/2011 None
N/A
DENTON
TX
ACTIVE
11/19/2010 None
N/A
FORT HOOD
FORT SAM
HOUSTON
TX
ACTIVE
11/6/2012 None
N/A
TX
ACTIVE
4/13/2012 None
N/A
ACTIVE
4/16/2012 None
N/A
ACTIVE
LICENSE
ISSUED
1/22/2013 None
N/A
12/17/2012 None
N/A
SAN ANTONIO TX
MCHENRY
IL
ACTIVE
1/29/2013 None
N/A
MCHENRY
IL
ACTIVE
1/29/2013 None
N/A
ACTIVE
8/19/2013 None
N/A
ACTIVE
LICENSE
ISSUED
1/19/2009 None
N/A
7/15/2010 None
N/A
HOUSTON
Page 57 of 301
6/3/2011 None
TX
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE
Disciplinary
Status Date
SUGAR LAND
GENERAL PRACTICE EL PASO
FAMILY MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
8/15/2011
8/15/2016 MEDICINE
EMERGENCY
12/1/2010
12/1/2015 MEDICINE
EMERGENCY
8/30/2013
8/30/2018 MEDICINE
EMERGENCY
8/15/2013
8/15/2018 MEDICINE
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
INTERNAL MEDICINE
EMERGENCY
5/16/2011
5/16/2016 MEDICINE
EMERGENCY
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
URGENT CARE
11/15/2010 11/15/2015 MEDICINE
MEDICINE
EMERGENCY
8/30/2013
8/30/2018 MEDICINE
J4947
Physician Name
OKORIE, BERTRAM
IHEANYICHUKWU, MD
H9393
OLIVER, ROBERT VERNE, MD
P7827
OLMSTED, THOMAS JAMES, DO
P7685
ONISKO, NANCY SUZANNE, DO
N4631
O'PATRY, SEAN DAVID , DO
P7175
ORDONEZ, EDGARDO, MD
N9758
ORRELL, JOSHUA JUDD, MD
N5924
ORTEGA, RAE LYNN, MD
N8134
ORTIZ, CHRISTOPHER ERIC, MD
P7829
OSLUND, SCOTT ALLEN, MD
M6325
OSORIO-GIRALDO, ALONSO
JAVIER, MD
P2910
OTTO, CHRISTIAN, MD
4/13/2012
N7855
OUTTEN, STEPHEN SINCLAIR, DO
10/1/2010
P6691
OUYANG, DA , MD
5/15/2013
P1911
1/17/2012
P6234
OWENS, ERIN MACDONALD, MD
OWENS, RICHARD ALEXANDER,
MD
P5862
PACKER, ALLAN DEAN, MD
3/15/2013
P7177
PADI, ABHILASH, MD
7/1/2013
P0652
PARKER, DAINA WYATT, MD
8/1/2011
4/9/2010
4/12/2013
EMERGENCY
4/9/2015 MEDICINE
EMERGENCY
4/13/2017 MEDICINE
EMERGENCY
10/1/2015 MEDICINE
EMERGENCY
5/15/2018 MEDICINE
EMERGENCY
1/17/2017 MEDICINE
EMERGENCY
4/12/2018 MEDICINE
EMERGENCY
3/15/2018 MEDICINE
EMERGENCY
7/1/2018 MEDICINE
EMERGENCY
8/1/2016 MEDICINE
FAMILY PRACTICE
FAMILY PRACTICE EMERGENCY MED
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
MESA
AZ
ACTIVE
8/19/2011 None
N/A
DALLAS
TX
12/6/2010 None
N/A
8/30/2013 None
N/A
8/15/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
CLEBURNE
TX
ACTIVE
1/29/2010 None
N/A
HOUSTON
TX
ACTIVE
7/16/2013 None
N/A
SEGUIN
TX
ACTIVE
LICENSE
ISSUED
5/24/2011 None
N/A
4/9/2010 None
N/A
1/21/2011 None
N/A
9/6/2013 None
N/A
4/9/2010 None
N/A
TEMPLE
TX
ACTIVE
WACO
TX
MOUNT
PLEASANT
IA
ACTIVE
TEXAS
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
4/27/2012 None
N/A
HOUSTON
TX
ACTIVE
10/14/2010 None
N/A
DALLAS
TX
ACTIVE
5/20/2013 None
N/A
ARLINGTON
TX
ACTIVE
2/29/2012 None
N/A
ANN ARBOR
MI
ACTIVE
4/19/2013 None
N/A
ROWLETT
TX
ACTIVE
LICENSE
ISSUED
4/1/2013 None
N/A
7/1/2013 None
N/A
ACTIVE
8/5/2011 None
N/A
HOUSTON
Page 58 of 301
Registration
Status of
Practice
Texas
State
License
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
L1690
PARSA, MICHAEL DARIUS, MD
2/5/2010
P6239
PASSANANTE, JOSEPH A, MD
4/12/2013
P6057
PATEL, DEVANG JITENDRA, MD
P0112
PATEL, NAMRATA MAHENDRA, MD
P6496
PATEL, PIKUL, MD
P7688
PATEL, SHALU SHARAD, MD
P6497
PATEL, ZUHAIB, DO
N4655
PATRICK, CASEY BROCK, MD
4/1/2013
6/15/2011
5/1/2013
8/15/2013
5/1/2013
11/6/2009
N3985
PAYNE, JOSHUA RUSH, MD
N6959
7/1/2010
N5328
PAZ, JUAN ENRIQUE, MD
PEACOCK, WILLIAM FRANKLIN IV,
MD
P7533
PEARSON, BRADLEY VANN, MD
8/1/2013
P2336
3/1/2012
L8885
PEARSON, NADIA MARY, DO
PELLICIA-RAMOS, LUIS ANTONIO,
MD
N2727
PENA, ALICE MERCEDES, MD
4/3/2009
P7184
PERES, NATANA NAVARRO, MD
7/1/2013
N4663
PETERSON, KYLE DAVID, MD
P5449
PETTIGREW, CANDACE DIANE, MD
P6245
PHAM, QUOC VAN, MD
PHILLIPS, CHRISTOPHER WEST,
MD
P5876
8/21/2009
2/5/2010
8/21/2009
11/6/2009
2/1/2013
4/12/2013
3/15/2013
EMERGENCY
2/5/2015 MEDICINE
EMERGENCY
4/12/2018 MEDICINE
EMERGENCY
4/1/2018 MEDICINE
EMERGENCY
6/15/2016 MEDICINE
EMERGENCY
5/1/2018 MEDICINE
EMERGENCY
8/15/2018 MEDICINE
EMERGENCY
5/1/2018 MEDICINE
EMERGENCY
11/6/2014 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
7/1/2015 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
EMERGENCY
8/1/2018 MEDICINE
EMERGENCY
3/1/2017 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
4/3/2014 MEDICINE
EMERGENCY
7/1/2018 MEDICINE
EMERGENCY
11/6/2014 MEDICINE
EMERGENCY
2/1/2018 MEDICINE
EMERGENCY
4/12/2018 MEDICINE
EMERGENCY
3/15/2018 MEDICINE
Secondary Specialty
(Self-Designated)
URGENT CARE
MEDICINE
URGENT CARE
MEDICINE
Page 59 of 301
SANTA
BARBARA
Registration
Status of
Practice
Texas
State
License
TEXAS
LICENSE
CA
ISSUED
AUSTIN
TX
DALLAS
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
ACTIVE
4/23/2013 None
N/A
TX
ACTIVE
4/4/2013 None
N/A
EL PASO
TX
ACTIVE
6/20/2011 None
N/A
OAK LAWN
IL
ACTIVE
5/3/2013 None
N/A
ACTIVE
9/4/2013 None
N/A
DALLAS
TX
ACTIVE
5/10/2013 None
N/A
HOUSTON
TX
ACTIVE
11/17/2009 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
8/27/2009 None
N/A
7/1/2010 None
N/A
2/5/2010 None
N/A
8/1/2013 None
N/A
3/1/2012 None
N/A
LAREDO
TX
ACTIVE
9/2/2009 None
N/A
AUSTIN
TX
ACTIVE
4/9/2009 None
N/A
HOUSTON
TX
ACTIVE
7/9/2013 None
N/A
BEAUMONT
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/27/2010 None
N/A
2/1/2013 None
N/A
4/12/2013 None
N/A
ACTIVE
3/29/2013 None
N/A
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
P6061
PHILLIPS, JUSTIN DANIEL, MD
4/1/2013
4/1/2018 MEDICINE
EMERGENCY
P5709
PILLUS, DAVID, MD
3/1/2013
3/1/2018 MEDICINE
EMERGENCY
EMERGENCY
N6583
PINNOW, JEFFERY MATTHEW, MD
6/4/2010
6/4/2015 MEDICINE
MEDICAL SERVICES
EMERGENCY
P2508
PITOTTI, CHRISTOPHER , MD
3/15/2012
3/15/2017 MEDICINE
PITTMAN, LAURA MARGUERITE,
EMERGENCY
N2248
MD
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
P2758
PLOTKIN, FREDRIC ROBERT, MD
4/2/2012
4/2/2017 MEDICINE
GENERAL PRACTICE
EMERGENCY
P7330
POLES, JOSH , DO
7/15/2013
7/15/2018 MEDICINE
EMERGENCY
N6585
PORTER, EMILY ANN, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
P3225
POTTER, ANDREW , DO
5/15/2012
5/15/2017 MEDICINE
EMERGENCY
N1077
PRATER, SAMUEL JOSIAH, MD
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
N8445
QUYSNER, ANNIE , MD
1/3/2011
1/3/2016 MEDICINE
EMERGENCY
P6504
RACEY, JEREMY CLYDE, MD
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
N5344
RAFIQUE, ZUBAID, MD
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
N4685
RAGO, OSCAR, MD
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
P6249
RALSTON, MELISSA FAITH, MD
4/12/2013
4/12/2018 MEDICINE
EMERGENCY
N9403
RAMSEY, JOSEPH ALONZO, MD
4/8/2011
4/8/2016 MEDICINE
EMERGENCY
P6066
RAWAT, ANISH , MD
4/1/2013
4/1/2018 MEDICINE
EMERGENCY
P6707
READER, SARA DWYER, MD
5/15/2013
5/15/2018 MEDICINE
EMERGENCY
N5965
READES, ROSALYN NICOLE, MD
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
P4503
REED, JANELLE LOUISE, MD
9/17/2012
9/17/2017 MEDICINE
Page 60 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
4/5/2013 None
N/A
ACTIVE
LICENSE
ISSUED
3/7/2013 None
N/A
6/4/2010 None
N/A
FT SAM
HOUSTON
TX
ACTIVE
3/21/2012 None
N/A
AUSTIN
TX
ACTIVE
2/11/2009 None
N/A
MIAMI
FL
ACTIVE
4/18/2012 None
N/A
ACTIVE
LICENSE
ISSUED
8/26/2013 None
N/A
6/4/2010 None
N/A
FORT WORTH TX
HOUSTON
TX
ACTIVE
6/4/2012 None
N/A
HOUSTON
CORPUS
CHRISTI
TX
ACTIVE
9/22/2008 None
N/A
TX
ACTIVE
1/7/2011 None
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/13/2013 None
N/A
2/5/2010 None
N/A
11/6/2009 None
N/A
ACTIVE
LICENSE
ISSUED
4/22/2013 None
N/A
4/8/2011 None
N/A
EAST
PATCHOGUE
NY
ACTIVE
4/3/2013 None
N/A
JACKSONVILL
E
FL
ACTIVE
5/27/2013 None
N/A
DALLAS
TX
ACTIVE
4/16/2010 None
N/A
ATHENS
TX
ACTIVE
11/22/2012 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
N4031
REID, RICHARD ROBERT , MD
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
N9770
REILAND, ALISON MARIE, MD
5/16/2011
5/16/2016 MEDICINE
EMERGENCY
P7841
REINHART, LARS , MD
8/30/2013
8/30/2018 MEDICINE
EMERGENCY
P4804
REYES, LUIS, MD
11/1/2012
11/1/2017 MEDICINE
EMERGENCY
P0784
RICE, CHRISTION GREGORY, MD
8/15/2011
8/15/2016 MEDICINE
EMERGENCY
P1216
RISCH, ROBERT MARTIN, MD
10/17/2011 10/17/2016 MEDICINE
EMERGENCY
N1861
ROBINSON, DEREK JERMAINE, MD 12/12/2008 12/12/2013 MEDICINE
RODRIGUEZ ACOSTA, MANUEL
EMERGENCY
P1017
EDUARDO, MD
9/15/2011
9/15/2016 MEDICINE
RODRIGUEZ-QUINONES, JULIO
EMERGENCY
P0786
JOSE, MD
8/15/2011
8/15/2016 MEDICINE
EMERGENCY
P6260
ROHRA, ANITA, MD
4/12/2013
4/12/2018 MEDICINE
EMERGENCY
P0668
ROOT, TIMOTHY DANFORTH, MD
8/1/2011
8/1/2016 MEDICINE
EMERGENCY
N6125
ROSE, JERI KING, DO
6/4/2010
6/4/2015 MEDICINE
ROSENBERRY, CLARK MICHAEL,
EMERGENCY
N9635
MD
5/2/2011
5/2/2016 MEDICINE
EMERGENCY
P1487
ROSLUND, GREGORY LANE, MD
11/15/2011 11/15/2016 MEDICINE
EMERGENCY
P4703
ROSS, DAVID JAMES, DO
10/15/2012 10/15/2017 MEDICINE
EMERGENCY
P5232
ROTHSTEIN, ROBERT JOSEPH, MD
1/4/2013
1/4/2018 MEDICINE
EMERGENCY
P5304
ROUNTREE, ANGELA RUTH, MD
1/15/2013
1/15/2018 MEDICINE
EMERGENCY
P6513
ROWE, ADAM EDWARD, MD
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
N5985
RUSCHER, ADAM, MD
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
N3284
SAEMI, AZALEA , MD
5/29/2009
5/29/2014 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
DALLAS
URGENT CARE
MEDICINE
Page 61 of 301
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
11/13/2009 None
N/A
ACTIVE
5/19/2011 None
N/A
ACTIVE
9/9/2013 None
N/A
ACTIVE
11/5/2012 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
8/26/2011 None
N/A
GRAPEVINE
TX
ACTIVE
11/8/2011 None
N/A
AUGUSTA
GA
ACTIVE
2/16/2009 None
N/A
AMARILLO
TX
ACTIVE
LICENSE
ISSUED
9/19/2011 None
N/A
8/15/2011 None
N/A
ACTIVE
4/30/2013 None
N/A
ACTIVE
LICENSE
ISSUED
8/25/2011 None
N/A
6/4/2010 None
N/A
5/12/2011 None
N/A
11/28/2011 None
N/A
10/15/2012 None
N/A
ACTIVE
1/8/2013 None
N/A
ACTIVE
1/31/2013 None
N/A
ACTIVE
5/8/2013 None
N/A
FLUSHING
EMERGENCY
MEDICAL SERVICES
Registration
Status of
Practice
Texas
State
License
NY
NOBLESVILLE IN
EL PASO
TX
ACTIVE
MISHAWAKA
IN
ACTIVE
LICENSE
ISSUED
BETHESDA
MD
HOUSTON
TX
ACTIVE
4/20/2010 None
N/A
TEMPLE
TX
ACTIVE
6/12/2009 None
N/A
License
Number
N1873
Physician Name
SALAZAR, GILBERTO ANTONIO,
MD
N1121
SALIB, TAMER , DO
N3285
SALINAS, JENNIFER SUSAN , MD
N2281
SALOOJA, RAHUL , MD
P3435
SALYER, RENA, DO
P6075
SANTOS, SUSANA, DO
P0490
SARATA, JEFFREY D, DO
P4811
SARTIN, MELISSA DAWN, MD
P3441
SAUTNER, JEREMY SCOTT, MD
N6986
P2063
SCHMICKRATH, SARAH JEAN, MD
SCHWIEGER, JENNIFER
MICHELLE, MD
SCIALDONE, ANTHONY MICHAEL,
MD
N9641
SCOTT, SARA B, MD
P4510
SCRIBNER, JAMES THOMAS, MD
P5571
SEUNGDAMRONG, JASON, MD
P7205
SHAH, AJITA RAJANIKANT, MD
P0874
P1696
SHAH, HEMALI , MD
J6239
SHAH, SAQIB MIAN, MD
N7491
SHAHIDI, HASSAN , DO
P1406
SHANKER, JASON ANDREW, DO
edicaid
edicaid
End Date
Designated)
EMERGENCY
12/12/2008 12/12/2013 MEDICINE
EMERGENCY
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
5/29/2009
5/29/2014 MEDICINE
EMERGENCY
2/6/2009
2/6/2014 MEDICINE
EMERGENCY
6/1/2012
6/1/2017 MEDICINE
EMERGENCY
4/1/2013
4/1/2018 MEDICINE
EMERGENCY
7/15/2011
7/15/2016 MEDICINE
EMERGENCY
11/1/2012
11/1/2017 MEDICINE
EMERGENCY
6/1/2012
6/1/2017 MEDICINE
EMERGENCY
7/1/2010
7/1/2015 MEDICINE
EMERGENCY
8/26/2011
8/26/2016 MEDICINE
EMERGENCY
2/1/2012
2/1/2017 MEDICINE
EMERGENCY
5/2/2011
5/2/2016 MEDICINE
EMERGENCY
9/17/2012
9/17/2017 MEDICINE
EMERGENCY
2/8/2013
2/8/2018 MEDICINE
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
EMERGENCY
12/15/2011 12/15/2016 MEDICINE
EMERGENCY
3/15/2012
3/15/2017 MEDICINE
EMERGENCY
8/16/2010
8/16/2015 MEDICINE
EMERGENCY
11/4/2011
11/4/2016 MEDICINE
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICAL SERVICES
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
DALLAS
TX
ACTIVE
2/9/2009 None
N/A
ALISO VIEJO
CA
ACTIVE
9/26/2008 None
N/A
HOUSTON
TX
ACTIVE
6/15/2009 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
3/31/2009 None
N/A
6/1/2012 None
N/A
SAN ANTONIO TX
ACTIVE
4/30/2013 None
N/A
SAN ANTONIO TX
ACTIVE
8/16/2011 None
N/A
DALLAS
WICHITA
FALLS
CORPUS
CHRISTI
TX
ACTIVE
11/6/2012 None
N/A
TX
ACTIVE
6/8/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/16/2010 None
N/A
8/26/2011 None
N/A
2/1/2012 None
N/A
MD
ACTIVE
5/30/2011 None
N/A
FORT WORTH TX
ACTIVE
9/21/2012 None
N/A
DALLAS
TX
ACTIVE
2/18/2013 None
N/A
AUSTIN
TX
ACTIVE
7/10/2013 None
N/A
HOUSTON
TX
ACTIVE
12/26/2011 None
N/A
INTERNAL MEDICINE MESQUITE
TX
ACTIVE
3/20/2012 None
N/A
TX
ACTIVE
8/19/2010 None
N/A
TX
ACTIVE
11/10/2011 None
N/A
BALTIMORE
EMERGENCY
MEDICINE
Page 62 of 301
DALLAS
CORPUS
CHRISTI
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
N5394
SHARMA, VIMI, DO
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
N9127
SHEEHAN, PAUL, MD
3/15/2011
3/15/2016 MEDICINE
EMERGENCY
P3583
SHELLENBERGER, JEFFRY, MD
6/8/2012
6/8/2017 MEDICINE
EMERGENCY
N8853
SHERMAN, VICTOR LEE, MD
2/15/2011
2/15/2016 MEDICINE
EMERGENCY
N5398
SHIELDS, STEPHEN DAMIEN, MD
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
P0878
SHLAMOVITZ, GIL ZVI, MD
8/26/2011
8/26/2016 MEDICINE
EMERGENCY
URGENT CARE
N1143
SHUFELDT, JOHN , MD
8/29/2008
8/29/2013 MEDICINE
MEDICINE
EMERGENCY
N9129
SHUKLA, PRANAV B, MD
3/15/2011
3/15/2016 MEDICINE
FAMILY PRACTICE
OSTEO
EMERGENCY
MANIPULATIVE
P1407
SHUMWAY, PRESTON WAYNE, DO
11/4/2011
11/4/2016 MEDICINE
MEDICINE
EMERGENCY
N7001
SILVER, BRAD JOSEPH, MD
7/1/2010
7/1/2015 MEDICINE
EMERGENCY
P1228
SINGH, HARBIR , MD
10/17/2011 10/17/2016 MEDICINE
EMERGENCY
P6088
SKEFOS, CHRYSTAN MARIA, MD
4/1/2013
4/1/2018 MEDICINE
SMITH, CODY WILLIAM DUNBAR,
EMERGENCY
P7710
MD
8/15/2013
8/15/2018 MEDICINE
EMERGENCY
P1229
SMITH, DUSTIN RICKY, MD
10/17/2011 10/17/2016 MEDICINE
EMERGENCY
N6030
SMITH, JEREMY RYAN, MD
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
N4115
SMITH, JORDAN MICHAEL, DO
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
P7210
SOLANO, ROY, MD
7/1/2013
7/1/2018 MEDICINE
EMERGENCY
P2790
SORENSEN, BRIAN SHAW, MD
4/2/2012
4/2/2017 MEDICINE
EMERGENCY
K6339
SORIA, DAVID MICHAEL, MD
8/26/2011
8/26/2016 MEDICINE
EMERGENCY
P3079
SORRENTINO, DAVID ALAN, DO
5/1/2012
5/1/2017 MEDICINE
Page 63 of 301
Practice City
MEMPHIS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TN
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
ACTIVE
3/28/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
6/12/2012 None
N/A
2/15/2011 None
N/A
2/5/2010 None
N/A
8/26/2011 None
N/A
PHOENIX
AZ
ACTIVE
9/17/2008 None
N/A
RICHMOND
TX
ACTIVE
4/6/2011 None
N/A
KALAMAZOO
MI
ACTIVE
11/30/2011 None
N/A
DALLAS
TX
ACTIVE
7/5/2010 None
N/A
DALLAS
TX
ACTIVE
10/24/2011 None
N/A
KATY
TX
ACTIVE
LICENSE
ISSUED
4/17/2013 None
N/A
8/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
11/16/2011 None
N/A
4/9/2010 None
N/A
DALLAS
TX
DALLAS
TX
ACTIVE
8/26/2009 None
N/A
DALLAS
TX
ACTIVE
7/25/2013 None
N/A
ABILENE
TX
ACTIVE
4/3/2012 None
N/A
DENISON
TX
ACTIVE
9/6/2011 None
N/A
TYLER
TX
ACTIVE
5/3/2012 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
SOWELL, ELIZABETH SANDOVAL,
EMERGENCY
N1161
MD
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
P6092
SPEARS, BRIAN THOMAS, MD
4/1/2013
4/1/2018 MEDICINE
EMERGENCY
P3588
SPEARS, GREGORY LYNN, MD
6/8/2012
6/8/2017 MEDICINE
EMERGENCY
N8065
ST CYR, CALEB JOSEPH, DO
10/29/2010 10/29/2015 MEDICINE
EMERGENCY
P5892
STANDIFER, JESSE ARTHUR II, MD
3/15/2013
3/15/2018 MEDICINE
EMERGENCY
N6686
STEINOUR, NICHOLAS PAUL, MD
6/4/2010
6/4/2015 MEDICINE
STEPHENS, NATHANIEL
EMERGENCY
P0301
BRANDON, DO
7/1/2011
7/1/2016 MEDICINE
EMERGENCY
N6688
STERN, ERIC WILLIAM, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
P7356
STEWART, JESSICA DANIELLE, MD
7/15/2013
7/15/2018 MEDICINE
EMERGENCY
N6043
STILLINGS, JOEL DAVID, DO
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
N6689
STITH, WILLIAM JOSEPH JR, DO
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
P4618
STOWELL, JEFFREY RANDAL, MD
10/1/2012
10/1/2017 MEDICINE
EMERGENCY
P6924
STRODER, RYAN ANDREW, DO
6/3/2013
6/3/2018 MEDICINE
EMERGENCY
N1164
STUART, STEPHANIE , MD
8/29/2008
8/29/2013 MEDICINE
EMERGENCY
P3673
STUBBS, WILL III, DO
6/15/2012
6/15/2017 MEDICINE
EMERGENCY
N9310
SUAREZ, GUILLERMO MANUEL, MD
4/1/2011
4/1/2016 MEDICINE
EMERGENCY
N8732
SUHR, EUNICE , MD
2/4/2011
2/4/2016 MEDICINE
EMERGENCY
N6696
SULLIVAN, JULIE MARIE, MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
N8996
SUMMERS, SHANE MICHAEL, MD
3/1/2011
3/1/2016 MEDICINE
EMERGENCY
N4144
SZEMA, ROBERT S, MD
8/21/2009
8/21/2014 MEDICINE
Secondary Specialty
(Self-Designated)
Page 64 of 301
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
BURNET
FL
TX
Disciplinary
Status Date
10/16/2008 None
N/A
4/8/2013 None
N/A
6/8/2012 None
N/A
10/29/2010 None
N/A
ACTIVE
LICENSE
ISSUED
3/19/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/6/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ORLANDO
Registration
Status Date
Disciplinary
Status of
Texas
License
PASADENA
TX
ACTIVE
7/16/2013 None
N/A
KILLEEN
TX
ACTIVE
LICENSE
ISSUED
4/26/2010 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
10/3/2012 None
N/A
FORT WORTH TX
ACTIVE
6/5/2013 None
N/A
TEMPLE
ACTIVE
9/8/2008 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
6/20/2012 None
N/A
4/1/2011 None
N/A
2/4/2011 None
N/A
6/4/2010 None
N/A
SAN ANTONIO TX
ACTIVE
3/11/2011 None
N/A
HOUSTON
ACTIVE
8/26/2009 None
N/A
HOUSTON
TEMPLE
TX
TX
TX
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
EMERGENCY
N4774
TAIWO, JOSEPH BABAFEMI, MD
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
P0504
TATE, SHERI L, DO
7/15/2011
7/15/2016 MEDICINE
EMERGENCY
N1469
TAYLOR, SABRINA , MD
10/10/2008 10/10/2013 MEDICINE
EMERGENCY
N2837
TERLECKI, THERESA MAROSI, MD
4/3/2009
4/3/2014 MEDICINE
EMERGENCY
N8862
TINSLEY, AMANDA SUZANNE, DO
2/15/2011
2/15/2016 MEDICINE
TOMANEC, ALAINYA VOLLMERING,
EMERGENCY
P7363
MD
7/15/2013
7/15/2018 MEDICINE
EMERGENCY
P1239
TORRES, JOEL , MD
10/17/2011 10/17/2016 MEDICINE
EMERGENCY
N6069
TORREZ, HEATHER DAWN, MD
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
P5744
TRACY, CHRISTINE ANNETTE, DO
3/1/2013
3/1/2018 MEDICINE
EMERGENCY
N3357
TRAN, MACLONG TONY, MD
5/29/2009
5/29/2014 MEDICINE
EMERGENCY
P2548
TRONCOSO, ALEXIS B, MD
3/15/2012
3/15/2017 MEDICINE
TROWBRIDGE, ALLISON MERNER,
EMERGENCY
N6726
MD
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
N7013
TU, YEN-TE, MD
7/1/2010
7/1/2015 MEDICINE
EMERGENCY
P7587
TULBERT, BRIAN WESLEY, DO
8/1/2013
8/1/2018 MEDICINE
EMERGENCY
N9489
TWILLEY, RUSH , MD
4/15/2011
4/15/2016 MEDICINE
EMERGENCY
N7015
UBAID, FARAH, MD
7/1/2010
7/1/2015 MEDICINE
EMERGENCY
P2552
VAKEY, DAVID KIRK, MD
3/15/2012
3/15/2017 MEDICINE
VELASQUEZ, GUSTAVO
EMERGENCY
N7508
GUILLERMO SR, MD
8/16/2010
8/16/2015 MEDICINE
EMERGENCY
P1942
VELOSO, JOSE, MD
1/17/2012
1/17/2017 MEDICINE
EMERGENCY
P1430
VU, BRIAN DAT, MD
11/4/2011
11/4/2016 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
LUBBOCK
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
11/11/2009 None
N/A
INTERNAL MEDICINE BURNET
TX
ACTIVE
7/20/2011 None
N/A
EL PASO
TX
ACTIVE
10/15/2008 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/17/2009 None
N/A
2/15/2011 None
N/A
7/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
10/24/2011 None
N/A
4/9/2010 None
N/A
4/29/2013 None
N/A
EL PASO
EMERGENCY
MEDICINE
TX
FORT WORTH TX
ACTIVE
DALLAS
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/4/2009 None
N/A
3/15/2012 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
7/16/2010 None
N/A
FORT WORTH TX
ACTIVE
8/2/2013 None
N/A
SAN ANTONIO TX
ACTIVE
4/25/2011 None
N/A
ACTIVE
7/27/2010 None
N/A
ACTIVE
LICENSE
ISSUED
3/23/2012 None
N/A
8/16/2010 None
N/A
HOUSTON
TX
INTERNAL MEDICINE
HOUSTON
TX
FAMILY PRACTICE
Page 65 of 301
AUSTIN
TX
ACTIVE
1/30/2012 None
N/A
HOUSTON
TX
ACTIVE
11/9/2011 None
N/A
License
Number
Physician Name
P3597
VU, TIM , MD
N8361
WALPOLE, AARON JAMISON, MD
P5757
WANG, BO, MD
N4833
WANG, HAO, MD
N6092
WANG, SEAN, MD
P2080
WARREN, WARD RANDALL, MD
P4726
WATTANA, MONICA , MD
P1709
WEBER, MICHAEL ANDREW, MD
N7892
WEDDEL, PAULA, MD
P2809
WEINER, DREW SCOTT, MD
P2171
WEIST, DAVID JOHN, MD
P0152
WELCH, SHARI JULE, MD
N6096
WESTFALL, AMANDA, MD
P2810
WHITE, MICHAEL JOSEPH, MD
N7028
WHITE, NOAH COOPER, MD
P1504
WHITLEY, DOUGLAS ELLIOTT, MD
N4201
WHITMAN, BRUCE STEVEN, DO
P1837
WHU, MAYBELLE STAEHELI, MD
P7870
WIESE, STEVEN MICHAEL, MD
N4203
WILLIAMS, ANNETTE LYNN , MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
6/8/2012
6/8/2017 MEDICINE
EMERGENCY
12/15/2010 12/15/2015 MEDICINE
EMERGENCY
3/1/2013
3/1/2018 MEDICINE
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
EMERGENCY
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
2/1/2012
2/1/2017 MEDICINE
EMERGENCY
10/15/2012 10/15/2017 MEDICINE
EMERGENCY
12/15/2011 12/15/2016 MEDICINE
EMERGENCY
10/1/2010
10/1/2015 MEDICINE
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
EMERGENCY
2/10/2012
2/10/2017 MEDICINE
EMERGENCY
6/15/2011
6/15/2016 MEDICINE
EMERGENCY
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
EMERGENCY
7/1/2010
7/1/2015 MEDICINE
EMERGENCY
11/15/2011 11/15/2016 MEDICINE
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
EMERGENCY
1/2/2012
1/2/2017 MEDICINE
FAMILY MEDICINE
EMERGENCY
8/30/2013
8/30/2018 MEDICINE
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
Page 66 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/8/2012 None
N/A
FALLS
CHURCH
VA
ACTIVE
1/21/2011 None
N/A
HOUSTON
TX
ACTIVE
3/5/2013 None
N/A
ACTIVE
11/11/2009 None
N/A
ACTIVE
4/26/2010 None
N/A
ACTIVE
LICENSE
ISSUED
2/20/2012 None
N/A
10/15/2012 None
N/A
SAN ANTONIO TX
TYLER
SULPHUR
SPRINGS
TX
ACTIVE
12/26/2011 None
N/A
TX
ACTIVE
10/6/2010 None
N/A
DALLAS
TX
ACTIVE
4/5/2012 None
N/A
KERRVILLE
SALT LAKE
CITY
TX
ACTIVE
2/16/2012 None
N/A
UT
ACTIVE
LICENSE
ISSUED
6/20/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
4/5/2012 None
N/A
FORT WORTH TX
ACTIVE
7/13/2010 None
N/A
TEMPLE
TX
ACTIVE
12/5/2011 None
N/A
LUMBERTON
NC
ACTIVE
11/18/2009 None
N/A
LAREDO
TX
ACTIVE
1/5/2012 None
N/A
ACTIVE
9/4/2013 None
N/A
ACTIVE
9/8/2009 None
N/A
SAN ANTONIO TX
License
Number
N9663
Physician Name
WILLIAMS, CHRISTOPHER
GEORGE, MD
N9420
WILLIAMS, DUSTIN BLAKE, MD
N5484
WILLIAMS, NAZANIN, MD
N7664
P0810
WILLIAMS, WENDIE RENEE, MD
WILSON, ANWAR COLLINWOOD,
MD
P3268
WILSON, GABRIEL ROLAND, MD
N8874
WILSON, JAMES, MD
N6104
WITTLER, MICAH, DO
N6774
WONG, DAVID CHUNWAN, MD
N3391
WOOD, IRA BICKHAM III, MD
N5489
P4918
WOOD, JASON , MD
WOOD-HORRALL, REBECCA
NAOMI, MD
WOODWARD PU, YEE-MING
PANDORA, MD
N1960
WOOLARD, ROBERT , MD
P0684
WRIGHT, JESSICA, MD
N5492
WU, STANLEY , MD
P6556
WYCOFF, ROBERT MARC, MD
N7191
YARIMA, WAKILI SALIHU, MD
N8160
YELVERTON, DAVID P, MD
N6783
YORK, CORTNIE, MD
P6553
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
5/2/2011
5/2/2016 MEDICINE
EMERGENCY
4/8/2011
4/8/2016 MEDICINE
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
9/1/2010
9/1/2015 MEDICINE
GERIATRICS
EMERGENCY
8/15/2011
8/15/2016 MEDICINE
EMERGENCY
5/15/2012
5/15/2017 MEDICINE
EMERGENCY
2/15/2011
2/15/2016 MEDICINE
EMERGENCY
4/9/2010
4/9/2015 MEDICINE
EMERGENCY
6/4/2010
6/4/2015 MEDICINE
EMERGENCY
5/29/2009
5/29/2014 MEDICINE
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
11/15/2012 11/15/2017 MEDICINE
EMERGENCY
12/12/2008 12/12/2013 MEDICINE
INTERNAL MEDICINE
EMERGENCY
8/1/2011
8/1/2016 MEDICINE
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
EMERGENCY
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
7/15/2010
7/15/2015 MEDICINE
EMERGENCY
11/15/2010 11/15/2015 MEDICINE
EMERGENCY
6/4/2010
6/4/2015 MEDICINE
Page 67 of 301
Practice City
PLANO
Registration
Status of
Practice
Texas
State
License
TX
SAN ANTONIO TX
AUSTIN
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
5/16/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/18/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
10/4/2010 None
N/A
8/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
5/21/2012 None
N/A
2/15/2011 None
N/A
4/9/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/17/2009 None
N/A
2/5/2010 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
5/7/2013 None
N/A
HOUSTON
TX
ACTIVE
1/7/2013 None
N/A
EL PASO
TX
ACTIVE
1/14/2009 None
N/A
8/5/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
2/5/2010 None
N/A
AUSTIN
TX
ACTIVE
5/29/2013 None
N/A
DEL RIO
TX
ACTIVE
7/26/2010 None
N/A
11/22/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
10/10/2008 10/10/2013 MEDICINE
EMERGENCY
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
5/15/2013
5/15/2018 MEDICINE
EMERGENCY
8/16/2010
8/16/2015 MEDICINE
FAMILY MEDICINE
N1500
ZAFAR, NADAH BANO, MD
P6560
ZHENG, KE, MD
P6755
ZIMMER, BRIAN MATTHEW, DO
N7517
ZIMMERMAN, BRETT EATON, MD
N7601
P5765
ZIMMERMAN, CINDY LOU, MD
ZIMMERMAN, MICHAEL PATRICK,
MD
N9667
ZINK, CHRISTINE LABENZ, MD
5/2/2011
P1721
AHMADI, SARA , MD
1/2/2012
P2186
ALVI, SAADIA , MD
3/1/2012
P5589
AZIZ, SHAHID, MD
3/1/2013
N4939
BECKER, JOSEPH RICHARD, MD
2/5/2010
P5049
CHAICHA-BROM, TIRA, MD
12/17/2012
P5049
12/17/2012
P5049
12/17/2012
P6799
CHOCKALINGAM, VIJAYARATNA ,
MD
8/27/2010
3/1/2013
6/3/2013
EMERGENCY
8/27/2015 MEDICINE
EMERGENCY
3/1/2018 MEDICINE
EMERGENCY
5/2/2016 MEDICINE
ENDOCRINOLOGY,
DIABETES AND
1/2/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
3/1/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
3/1/2018 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
2/5/2015 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
12/17/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
ENDOCRINOLOGY,
DIABETES AND
ENDOCRINOLOGY,
DIABETES AND
6/3/2018 METABOLISM
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
10/24/2008 None
N/A
ACTIVE
5/13/2013 None
N/A
AMARILLO
TX
ACTIVE
5/20/2013 None
N/A
VICTORIA
TX
ACTIVE
9/17/2010 None
SEE
PREVIOUS
8/27/2010 ORDER
N/A
LICENSE
ISSUED
8/30/2010
ROUND ROCK TX
ACTIVE
4/2/2013 None
N/A
SAN ANTONIO TX
ACTIVE
5/19/2011 None
N/A
GALVESTON
TX
ACTIVE
1/4/2012 None
N/A
TX
ACTIVE
3/30/2012 None
N/A
ACTIVE
3/7/2013 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
2/5/2010 None
N/A
INTERNAL MEDICINE AUSTIN
TX
ACTIVE
12/18/2012 None
N/A
TX
ACTIVE
12/18/2012 None
N/A
TX
ACTIVE
12/18/2012 None
N/A
6/3/2013 None
N/A
INTERNAL MEDICINE
Page 68 of 301
LICENSE
ISSUED
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
ENDOCRINOLOGY,
CHOUDHRY, MUHAMMAD IMRAN,
DIABETES AND
N0701
MD
8/29/2008
ENDOCRINOLOGY,
CORDOBA KISSEE, MICHELLE
DIABETES AND
P7092
LYNN, MD
7/1/2013
7/1/2018 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
N7080
DUNNIGAN, ERIN ELIZABETH, MD
7/15/2010
ENDOCRINOLOGY,
DURODOYE, OLUYEMISI MODINAT,
DIABETES AND
N9044
MD
3/15/2011
ENDOCRINOLOGY,
DIABETES AND
N7421
FELTON, SHAILI KHANDHERIA, MD
8/16/2010
ENDOCRINOLOGY,
DIABETES AND
P5282
KATHURIA, AMITA, MD
1/15/2013
ENDOCRINOLOGY,
DIABETES AND
P6197
KIM, JONGOH , MD
4/12/2013
ENDOCRINOLOGY,
DIABETES AND
J1293
LENDER, DAN, MD
7/1/2011
7/1/2016 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
P1352
MAI, FLOWER HOANG, DO
11/4/2011
ENDOCRINOLOGY,
DIABETES AND
N9748
MIRANDA, JENNIFER JOANNE, MD
5/16/2011
ENDOCRINOLOGY,
DIABETES AND
P1901
MITTAN, DANIELLA MARIANA, MD
1/17/2012
ENDOCRINOLOGY,
DIABETES AND
P1675
NIEGOS, FREDERICK BOADO, MD
12/15/2011 12/15/2016 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
N7647
PANJA, SRINIVAS RAO, MD
9/1/2010
9/1/2015 METABOLISM
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
INTERNAL MEDICINE MARQUETTE
MI
ACTIVE
9/9/2008 None
N/A
INTERNAL MEDICINE EDINBURG
TX
ACTIVE
7/10/2013 None
N/A
TX
ACTIVE
7/21/2010 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
3/15/2011 None
N/A
INTERNAL MEDICINE
ACTIVE
8/19/2010 None
N/A
TX
ACTIVE
1/28/2013 None
N/A
TX
LICENSE
ISSUED
4/12/2013 None
N/A
TX
ACTIVE
7/7/2011 None
N/A
SULPHUR
INTERNAL MEDICINE SPRINGS
TX
ACTIVE
11/10/2011 None
N/A
EAST
PROVIDENCE RI
ACTIVE
5/30/2011 None
N/A
COLLEGE
INTERNAL MEDICINE STATION
TX
ACTIVE
1/19/2012 None
N/A
INTERNAL MEDICINE VICTORIA
TX
ACTIVE
1/3/2012 None
N/A
ACTIVE
10/26/2010 None
N/A
INTERNAL MEDICINE
Page 69 of 301
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
ENDOCRINOLOGY,
DIABETES AND
H8318
PENDERGRASS, MERRI LOU , MD
12/12/2008 12/12/2013 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
N6589
PUTHOORAN, SONIA A, MD
6/4/2010
6/4/2015 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
P4998
RAGHUWANSHI, ANITA P, MD
11/30/2012 11/30/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
N1424
RAHNEMA, MOLOUK , MD
10/10/2008 10/10/2013 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
N9483
RIVERA, DINA CELINE, MD
4/15/2011
ENDOCRINOLOGY,
DIABETES AND
N8343
SAIF, NOMAN , MD
12/15/2010 12/15/2015 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
N8982
SAN JUAN, ZINNIA TAN, MD
3/1/2011
3/1/2016 METABOLISM
ENDOCRINOLOGY,
SIDWANI-CHAWLA, SEEMA LAKHO,
DIABETES AND
P5136
DO
12/17/2012 12/17/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
P5136
DO
12/17/2012 12/17/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
P5136
DO
12/17/2012 12/17/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
N4756
SINNOTT, BRIDGET P, MD
11/6/2009
ENDOCRINOLOGY,
DIABETES AND
P2807
WALLACE, MARK KOWALSKI, MD
4/2/2012
4/2/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
J1426
WENZEL, MARC EVAN, MD
8/1/2011
8/1/2016 METABOLISM
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
2/9/2009 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
6/4/2010 None
N/A
DALLAS
TX
ACTIVE
12/4/2012 None
N/A
TX
ACTIVE
10/15/2008 None
N/A
ACTIVE
4/27/2011 None
N/A
ACTIVE
1/10/2011 None
N/A
ACTIVE
3/14/2011 None
N/A
ROUND ROCK TX
ACTIVE
12/28/2012 None
N/A
ROUND ROCK TX
ACTIVE
12/28/2012 None
N/A
ROUND ROCK TX
ACTIVE
12/28/2012 None
N/A
TX
ACTIVE
11/16/2009 None
N/A
TX
ACTIVE
4/4/2012 None
N/A
ACTIVE
8/8/2011 None
N/A
INTERNAL MEDICINE
INTERNAL MEDICINE SALEM
NJ
INTERNAL MEDICINE
Page 70 of 301
NEW
BRAUNFELS
License
Number
Physician Name
N7719
MAUD, ALBERTO, MD
N7382
ZIEGLER, JORDAN I, MD
STALLWORTH, CHRISTIAN LANE,
MD
N6679
N5446
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
Practice City
ENDOVASCULAR
SURGICAL
VASCULAR
9/15/2010
9/15/2015 NEURORADIOLOGY
NEUROLOGY
EL PASO
NEUROLOGY/DIAGN
ENDOVASCULAR
OSTIC
SURGICAL
RAD/NEURORADIOLO
8/2/2010
GY
AUSTIN
FACIAL PLASTIC
6/4/2010
6/4/2015 SURGERY
OTOLARYNGOLOGY
FACIAL PLASTIC
2/5/2010
2/5/2015 SURGERY
OTOLARYNGOLOGY
P7055
N1510
UNDAVIA, SAMIR SURESH, MD
ABANG-HAYES, SARAH NICOLE,
MD
ABDELMOULA, MOHAMED MAHDY,
MD
ABDEL-REHIM, MOHAMED SABER,
MD
ABDULLA, CEDELA , MD
P6119
ABID, HUMAIRA -, MD
P2819
N7985
ABRAHAM, GEORGE , MD
ADELEYE, VICTORIA M, MD
4/13/2012
4/13/2017 FAMILY MEDICINE
10/29/2010 10/29/2015 FAMILY MEDICINE
P5019
ADESANYA, ISMAIL OLAYINKA, MD
12/17/2012 12/17/2017 FAMILY MEDICINE
P5019
12/17/2012 12/17/2017 FAMILY MEDICINE
P5019
P1257
12/17/2012 12/17/2017 FAMILY MEDICINE
11/4/2011
P4922
AGRAWAL, MONICA , MD
AGUILAR, DEBORAH CHRISTINA,
MD
AGUINAGA, MARIA DE LOURDES,
MD
N6802
AGUIRRE, JOSE WILLIAM, MD
7/1/2010
N6131
AGUORU, OKEZIE STANLEY, MD
6/4/2010
N7047
AHMED, MOHAMMAD , MD
7/15/2010
P2817
P0328
N9798
4/13/2012
7/15/2011
7/1/2013
12/12/2008 12/12/2013 FAMILY MEDICINE
4/12/2013
6/3/2011
HOUSTON
FAMILY MEDICINE
FAMILY PRACTICE
11/30/2012 11/30/2017 FAMILY MEDICINE
HOSPITALIST
Page 71 of 301
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
9/20/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
9/13/2010 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
4/13/2012 None
N/A
8/5/2011 None
N/A
7/16/2013 None
1/27/2009 None
N/A
N/A
4/12/2013 None
UNDER
BOARD
4/13/2012 ORDER
11/4/2010 None
N/A
TX
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/13/2012
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
11/8/2011 None
N/A
N/A
6/3/2011 None
N/A
11/30/2012 None
N/A
7/1/2010 None
N/A
6/4/2010 None
N/A
7/15/2010 None
N/A
License
Number
N8264
N7899
Physician Name
AJALA, MOYOSADE ADEYINKA, MD
AKIN, ANGELA RENEE, DO
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
12/15/2010 12/15/2015 FAMILY MEDICINE
10/15/2010 10/15/2015 FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
GERIATRICS
P0332
P6314
P0948
P2184
P0334
ALAM, MD MONJURUL, MD
ALAM, NIMAT , MD
ALEXANDER, AMITA, MD
ALFORD, ERIC NATHAN, MD
ALI, FOZIA AKHTAR, MD
7/15/2011
5/1/2013
9/15/2011
3/1/2012
7/15/2011
7/15/2016
5/1/2018
9/15/2016
3/1/2017
7/15/2016
N7388
P1515
8/16/2010
12/1/2011
P7058
ALJAWADI, GEORGIA , DO
ALLAIRE, BO JONATHAN, MD
ALSOBROOKS, CURRISSA PRUITT,
MD
7/1/2013
J6300
ALSOP, ERNEST CARSON, MD
5/16/2011
FAMILY PRACTICE
N4905
AMBREEN, FARHANA, MD
2/5/2010
FAMILY PRACTICE
N9339
4/8/2011
P2944
N6807
AMBY, ALEXANDER SCOTT, MD
AMECHI-OBIGWE, ADANNA JULIET,
MD
AMER, ISRA MOHAMMAD, MD
5/1/2012
7/1/2010
P6127
ANAYA, SAMUEL JR, MD
4/12/2013
P6574
N9164
ANUGWOM, CHINASA PAUL, MD
AQUINO-WHITE, AIMEE, DO
5/15/2013
4/1/2011
P1160
N7390
P6773
ARABZADEH, PAYMAN, MD
ARES-VALDES, NIXCELA, MD
ARIAS, GABRIELA AGUAYO, MD
N0613
ARROYAVE, ANA MARIA, MD
P5154
ARUN, MATHAGONDAPALLY S, MD
10/17/2011 10/17/2016 FAMILY MEDICINE
8/16/2010
6/3/2013
8/29/2008
1/4/2013
CEDAR PARK
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
ODESSA
LEVELLAND
WACO
TX
TX
TX
CORPUS
CHRISTI
BAYTOWN
TX
TX
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
12/15/2010 None
10/20/2010 None
Disciplinary
Status Date
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/25/2011
5/9/2013
9/23/2011
3/13/2012
7/28/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/8/2010 None
12/5/2011 None
N/A
N/A
7/1/2013 None
UNDER
BOARD
5/27/2011 ORDER
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/3/2011
2/5/2010 None
N/A
4/8/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/10/2012 None
7/14/2010 None
N/A
N/A
4/12/2013 None
N/A
EMERGENCY
MEDICINE
URGENT CARE FAMILY PRACTICE
ELK RIVER
MN
ACTIVE
ACTIVE
5/20/2013 None
4/11/2011 None
N/A
N/A
FAMILY PRACTICE
LAKE
JACKSON
BELLAIRE
TX
TX
ACTIVE
ACTIVE
ACTIVE
10/20/2011 None
9/6/2010 None
6/12/2013 None
N/A
N/A
N/A
TX
ACTIVE
9/12/2008 None
N/A
AL
ACTIVE
2/28/2013 None
N/A
PREVENTIVE
MEDICINE
EL PASO
PUBLIC
HEALTH/PREVENTIVE
MEDICINE
(GENERAL)
HUNTSVILLE
Page 72 of 301
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
TX
ISSUED
N8757
ASHFAQUE, AMBREEN , MD
2/15/2011
DALLAS
P7742
P2581
8/30/2013
4/2/2012
SHREVEPORT LA
DALLAS
TX
P7383
ATAEI, HOMAYOUN, MD
ATREY, VARTIKA , MD
AVILA ACOSTA, ADRIANA JANETH,
MD
8/1/2013
P4629
N7212
AVILA, LYDIA, MD
AYALA, JOSE-RUBEN , MD
N1986
AYERS, KARYN MARIE JESTER, MD
2/6/2009
N6153
AYUB, ASMA, MD
6/4/2010
P2950
N5544
BACKLUND, AMANDA JANINE, MD
BAH, ELIZABETH LEIGH, DO
5/1/2012
4/9/2010
10/15/2012 10/15/2017 FAMILY MEDICINE
8/2/2010
N7214
BAHMANPOUR, KAVEH , MD
P2954
P5028
P5028
P5028
P7386
P3118
N5564
BALLA, JUSTIN DOMINIQUE, MD
BANGA, MADHUMITA, MD
BARKLEY, SHANNON, MD
BARNING, KENNETH , MD
BEENE, CHRISTOPHER LEE, MD
5/1/2012
12/17/2012 12/17/2017 FAMILY MEDICINE
12/17/2012 12/17/2017 FAMILY MEDICINE
12/17/2012 12/17/2017 FAMILY MEDICINE
8/1/2013
5/15/2012
4/9/2010
P1165
P2956
N7523
BELCHER, MEGAN ELIZABETH, DO
BENDER, NATHAN SCOTT, MD
BENITEZ, ADOLFO L, MD
10/17/2011 10/17/2016 FAMILY MEDICINE
5/1/2012
8/27/2010
P1727
BERRY, SHANNON GAYLE, MD
1/2/2012
P4422
BHAVSAR, JENNIFER, MD
BHUSARI, VAISHALI KAWADUJI,
MD
BLACKBURN, MATTHEW , DO
9/17/2012
7/15/2011
4/9/2010
P0348
N5512
8/2/2010
INTERNAL MEDICINE EL PASO
FAMILY PRACTICE - OKLAHOMA
EMERGENCY MED
CITY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
HOSPITALIST
Page 73 of 301
TX
OK
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/15/2011 None
N/A
9/6/2013 None
4/23/2012 None
N/A
N/A
8/1/2013 None
N/A
10/15/2012 None
8/5/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
2/16/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LUBBOCK
DALLAS
TX
TX
ACTIVE
ACTIVE
5/14/2012 None
4/28/2010 None
N/A
N/A
FONTANA
CA
ACTIVE
8/23/2010 None
N/A
HOUSTON
SPRINGFIELD
SPRINGFIELD
SPRINGFIELD
HOUSTON
PASADENA
TX
IL
IL
IL
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
5/7/2012
12/26/2012
12/26/2012
12/26/2012
8/13/2013
5/30/2012
4/26/2010
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
SUGAR LAND
SUGAR LAND
EL PASO
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
10/26/2011 None
5/3/2012 None
9/1/2010 None
N/A
N/A
N/A
FORT WORTH
COLLEGE
STATION
WICHITA
FALLS
WACO
TX
ACTIVE
2/28/2012 None
N/A
TX
ACTIVE
9/19/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
7/25/2011 None
4/13/2010 None
N/A
N/A
License
Number
Physician Name
N3505
P0552
BLOUNT, BENROE WAYNE, MD
BOHN, SARAH BETH, MD
N6186
N9816
edicaid
edicaid
End Date
Designated)
8/21/2009
8/1/2011
BRADY, JESSICA , MD
6/4/2010
BREDY, BRUNEL, MD
BROUSSARD, JOHNECA
ROCHELLE, DO
6/3/2011
4/12/2013
6/15/2011
8/21/2009
P6594
BURT, SELINA ANDREA, DO
CABRA, OMAR HUMBERTO , MD
CALA MORALES, CLAUDIA LUCIA,
MD
5/15/2013
P3297
N8383
CAMACHO, ALLAN CASTILLO, MD
CAMPOS, REBECCA LEE, MD
6/1/2012
1/3/2011
P7083
CANTU, JAMES ARNOLD, MD
7/1/2013
N3532
P0707
CANTU, MARIBEL , MD
CANTU, SERGIO SAUL, MD
8/21/2009
8/15/2011
N8770
N8496
P4636
P0964
CAO, HIEP ANDREW, MD
CARPIO, BERNARDO , MD
CASAS, CHEYANNE MARIE, MD
CERNA, NORMA CAROLINA, MD
P5785
P4429
P4939
CHALLA, SOUJANYA, MD
CHAMBERS-KERSH, LAURA SINDA,
MD
CHANDLER, WEST, MD
N6212
CHANDRASENAN, SACHIN, MD
6/4/2010
P0561
N8897
N2027
CHAO, STEPHEN KEN-WEI, MD
CHAPA, JUDITH , MD
CHAU, LIEU NGOC, DO
8/1/2011
3/1/2011
2/6/2009
P6146
P0014
N3530
Secondary Specialty
(Self-Designated)
PREVENTIVE
MEDICINE
Practice City
FREDERICKSB
URG
TX
SAN ANTONIO TX
KERRVILLE
FAMILY PRACTICE
EMERGENCY
MEDICINE
TX
SAN ANTONIO TX
KINGSVILLE
TX
BROWNSVILL
E
TX
HOSPITALIST
2/15/2011
1/18/2011
10/15/2012 10/15/2017 FAMILY MEDICINE
9/15/2011
3/15/2013
Registration
Status of
Practice
Texas
State
License
SAN ANGELO
TX
9/17/2012
11/30/2012 11/30/2017 FAMILY MEDICINE
OBSTETRICS
FT HOOD
MARSHALL
TX
TX
MCALLEN
TX
SAN ANTONIO TX
Page 74 of 301
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/28/2009 None
8/5/2011 None
N/A
N/A
6/4/2010 None
UNDER
BOARD
6/13/2011 ORDER
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/16/2013 None
N/A
6/15/2011 None
9/21/2009 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/18/2013 None
N/A
6/1/2012 None
1/11/2011 None
N/A
N/A
7/8/2013 None
N/A
8/26/2009 None
8/19/2011 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
2/15/2011
1/21/2011
10/17/2012
9/19/2011
6/3/2011
None
None
None
None
N/A
N/A
N/A
N/A
3/15/2013 None
N/A
10/9/2012 None
12/24/2012 None
N/A
N/A
6/4/2010 None
N/A
8/1/2011 None
3/4/2011 None
3/9/2009 None
N/A
N/A
N/A
License
Number
P1738
P1739
Physician Name
edicaid
edicaid
End Date
Designated)
3/15/2012
2/1/2012
8/1/2011
2/5/2010
8/27/2010
Practice City
P2427
CHEN, DONGNING, MD
CHEN, YEN I GRACE, MD
CHENNAREDDY, KIRAN KUMAR,
MD
P1978
P0564
CHHIPWADIA, AMISHA S, MD
CHINTALA, NARANATH, MD
N4987
N7530
N2446
P2621
CHUA, ALBERT JOSEPH, MD
CHUDEJ, ERIC , MD
CHUGHTAI-HARVEY, ISABELLE
CLAIRE, MD
CLAUS, STEPHANIE ELISE, MD
COIMBRA, MARIA DE LOURDES
MOUTTA CALADO, MD
COKER, BRIDGETTE DENISE, MD
P0566
COKER, KARAH LYNN, MD
P6361
P1064
COLLINS, CHRISTOPHER JOEL, MD
CONNOR, BRYNNA , MD
N7912
P1450
N5639
COOPER, MICHAEL ANDREW, MD
COSGROVE, AMY DANIELLE, MD
COTTER, HEATH EARL, MD
N4364
CRIM, CHAD DAVID, MD
8/15/2013
WACO
TX
N7410
N3589
CUNNINGHAM, KELLY EILEEN, MD
CURBOW, AMIE RACHELLE, MD
8/16/2010
8/21/2009
CONROE
TX
N7076
DABU, DARNEL VIRAY, MD
7/15/2010
N4350
N6841
1/2/2012
1/2/2012
Secondary Specialty
(Self-Designated)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
SAN ANTONIO TX
HOSPITALIST
FT. WORTH
TX
WACO
TX
11/6/2009
7/1/2010
SACRAMENTO CA
WACO
TX
4/3/2009
4/2/2012
8/1/2011
5/1/2013
10/3/2011
10/15/2010 10/15/2015 FAMILY MEDICINE
11/15/2011 11/15/2016 FAMILY MEDICINE
4/9/2010
P0969
N5645
DACUMOS, NANETTE REYES, MD
DAVIS, KURTIS WILLIAM, MD
9/15/2011
4/9/2010
P1287
DE LEON, OSCAR , MD
11/4/2011
INTERNAL MEDICINE MCALLEN
GARLAND
FAMILY PRACTICE
OBSTETRICS
FAMILY PRACTICE
Page 75 of 301
LONGVIEW
AUSTIN
TX
TX
WA
TX
FORT WORTH TX
MADISONVILL
E
TX
BRYAN
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
1/6/2012 None
1/5/2012 None
N/A
N/A
3/15/2012 None
N/A
2/1/2012 None
8/5/2011 None
N/A
N/A
2/5/2010 None
9/7/2010 None
N/A
N/A
11/19/2009 None
7/13/2010 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/18/2009 None
4/9/2012 None
N/A
N/A
8/1/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
5/7/2013 None
11/16/2011 None
N/A
N/A
10/15/2010 None
11/17/2011 None
4/21/2010 None
N/A
N/A
N/A
8/15/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/19/2010 None
10/7/2009 None
N/A
N/A
7/15/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/21/2011 None
5/3/2010 None
N/A
N/A
11/4/2011 None
N/A
ACTIVE
ACTIVE
License
Number
N7534
Physician Name
DHILLON, JASPINDER SINGH, MD
P4565
N0730
P4860
DIAMOND, MICHAEL JEREMY, MD
DIAZ, MARCO , MD
DICKERSON, JEREMY LEE, MD
N8642
DINKINS, RICHARD SCOTT, MD
N5019
N5654
P4753
N7079
P0375
P5969
N8908
P3527
N5513
edicaid
edicaid
End Date
Designated)
8/27/2010
10/1/2012
8/29/2008
11/15/2012 11/15/2017 FAMILY MEDICINE
2/4/2011
DIXON, JARED , MD
DO, DOAN THUY, MD
DODD, JAMES RUSSELL, MD
2/5/2010
4/9/2010
11/1/2012
DOE, JAMES YAO, MD
DOMMARAJU, SUBHA RAJITHA ,
MD
7/15/2010
7/15/2011
DONELSON, JULIA ANNE, MD
DUPERVAL-BROWNLEE,
TAMARAH, MD
4/1/2013
3/1/2011
DVORAK, DERRICK WILLIAM, MD
EBERT-BLACKBURN, DIDI ELISE,
DO
6/8/2012
4/9/2010
P7430
ELIZARRARAS, HERIBERTO , MD
8/1/2013
P1069
N7419
N3632
P1639
ELLENBECKER, BEAU JAMES, DO
ELLIS, ANDREA MARIE, MD
ELSAID, SALEH , MD
EMORY, RONYA LASHELLE, MD
P1749
ESCHBERGER, ANNE MARIE , MD
1/2/2012
N5042
P6966
2/5/2010
6/14/2013
P1860
P5973
ESCOBAR, JORGE JAVIER JR, MD
ESPARZA, LUIS MIGUEL, MD
ESQUIVEL-VANEGAS, GERMAN
ROMAN, MD
ETEMADI, ALIREZA, MD
1/17/2012
4/1/2013
P7107
EVERETT, JEREMY CHAD, DO
7/1/2013
10/3/2011
10/3/2016
8/16/2010
8/16/2015
8/21/2009
8/21/2014
12/15/2011 12/15/2016
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
Secondary Specialty
(Self-Designated)
GERIATRICS
EMERGENCY
MEDICINE
Practice City
CARRIZO
SPRINGS
EL PASO
TYLER
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
TX
TX
EMERGENCY
MEDICINE
HOUSTON
SUGAR LAND
AUSTIN
TX
TX
TX
EMERGENCY
MEDICINE
WACO
TX
EMERGENCY
MEDICINE
FAMILY MEDICINE
APO
AE
GALVESTON
GARLAND
TX
TX
BRYAN
TX
LUBBOCK
TX
MCALLEN
ALISO VIEJO
TX
CA
OBSTETRICS
Page 76 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/27/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
10/3/2012 None
10/27/2008 None
11/27/2012 None
N/A
N/A
N/A
2/4/2011 None
N/A
2/5/2010 None
4/28/2010 None
11/16/2012 None
N/A
N/A
N/A
7/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/8/2011 None
N/A
4/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
3/23/2011 None
N/A
6/8/2012 None
N/A
ACTIVE
LICENSE
ISSUED
4/14/2010 None
N/A
8/1/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/31/2011
8/23/2010
10/14/2009
1/5/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
1/17/2012 None
N/A
2/5/2010 None
6/18/2013 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
1/23/2012 None
4/12/2013 None
N/A
N/A
7/1/2013 None
N/A
License
Number
N5045
N7255
P1457
N8784
P0209
P3529
N0763
P0582
Physician Name
FAGLIE, BRAD D, MD
FAJARDO, ARTHUR BERNARD TIU,
MD
FARRACH, HUSSEM ALEJANDRO,
MD
FELICITAS, PATRICK STEPHEN
TAN, MD
FEY, VICTOR, MD
FIELDS, JOANNA RENEE, MD
FIGUEREDO, GIOVANNA, MD
edicaid
edicaid
End Date
Designated)
2/5/2010
8/2/2010
11/15/2011 11/15/2016 FAMILY MEDICINE
2/15/2011
7/1/2011
6/8/2012
8/29/2008
2/15/2016
7/1/2016
6/8/2017
8/29/2013
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FILIPETTO, FRANK ANTHONY, DO
FILLINGANE, CHARLES SAMUEL II,
DO
FITE, MICHAEL QUENTIN, MD
8/1/2011
8/1/2013
8/2/2010
6/4/2010
P5065
N6870
FRANCE, RATCHNEE -, MD
FRANCISCO, ANNA MARIE
TUNGOL, MD
TUNGOL, MD
TUNGOL, MD
FREITAG, FREDERICK G., DO
P3152
N8188
GADDIS, TODD DONAVON, MD
GAMBOA, DANIELA , MD
N9857
GARCIA, ANGEL JOEL, MD
P7438
N7258
N6302
P5065
P5065
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICINE
FAMILY PRACTICE
OBSTETRICS
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
KERMIT
TX
ACTIVE
ARDMORE
OK
CLINTON
LAREDO
HOUSTON
OK
TN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
SAGINAW
TX
ACTIVE
PORT LAVACA TX
SUGAR LAND TX
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
8/27/2010 None
N/A
11/25/2011 None
N/A
2/15/2011
7/12/2011
6/18/2012
12/1/2008
None
None
None
None
N/A
N/A
N/A
N/A
8/5/2011 None
N/A
8/13/2013 None
9/27/2010 None
N/A
N/A
6/4/2010 None
N/A
12/17/2012 12/17/2017 FAMILY MEDICINE
ODESSA
TX
ACTIVE
1/7/2013 None
N/A
12/17/2012 12/17/2017 FAMILY MEDICINE
ODESSA
TX
ACTIVE
1/7/2013 None
N/A
12/17/2012 12/17/2017 FAMILY MEDICINE
7/1/2010
ODESSA
DALLAS
TX
TX
1/7/2013 None
7/8/2010 None
N/A
N/A
AMARILLOT
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
5/15/2012 None
12/23/2010 None
N/A
N/A
6/3/2011 None
N/A
5/15/2012
12/1/2010
6/3/2011
P0724
P4447
GARZA, TRINI JON, MD
GENTRY, JAMES DUSTIN, MD
8/15/2011
9/17/2012
N7800
GHATALI, MOHAMMAD AGHIL, MD
10/1/2010
P2000
N0788
N3675
N8919
GHUMMAN, UMAR, MD
GIDDALURI, PRAKASH , MD
GILL, SHIVJIT SINGH, MD
GIPSON, JASON LOGAN, MD
2/1/2012
8/29/2008
8/21/2009
3/1/2011
2/1/2017
8/29/2013
8/21/2014
3/1/2016
FAMILY PRACTICE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
RIO GRANDE
CITY
TYLER
TX
TX
ACTIVE
ACTIVE
8/19/2011 None
10/26/2012 None
N/A
N/A
FABEN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
10/13/2010 None
N/A
2/1/2012
10/31/2008
8/26/2009
4/25/2011
N/A
N/A
N/A
N/A
SEALY
TX
LEAGUE CITY TX
TYLER
TX
Page 77 of 301
None
None
None
None
License
Number
P2244
P4956
N3677
P4959
P6970
N7233
P2253
P1646
P5184
P0395
P6627
Physician Name
GIRGIS, GEORGE WAGIH
YOUSSEF, MD
GIVENS, KELLY , MD
GOLDSTEIN, PETER ELLIOT, MD
GONZALEZ, MARIO G, MD
GOUX, VINCENT PAUL, MD
GRAY, MOLLY BROOKS, DO
GU, YING, MD
GUERRA VALENCIA, EDUARDO
MIGUEL, MD
GULBIS, ANDREW JOHN, MD
edicaid
edicaid
End Date
Designated)
3/1/2012
11/30/2012 11/30/2017 FAMILY MEDICINE
8/21/2009
11/30/2012 11/30/2017 FAMILY MEDICINE
6/14/2013
8/2/2010
3/1/2012
12/15/2011 12/15/2016 FAMILY MEDICINE
1/4/2013
N1665
GUTIERREZ, MARIO A, MD
GUZMAN, ALFONSO JR, MD
GUZMAN, CHRISTOPHER
ZIPAGAN, MD
P7454
P0728
N5703
P3166
HAGOS, ELILTA M, MD
HAIDER, AMAN , MD
HAKES, JOSEPH D., MD
HAMDARD, FARAH, MD
8/1/2013
8/15/2011
4/9/2010
5/15/2012
8/1/2018
8/15/2016
4/9/2015
5/15/2017
P0403
HANIF, SYRA, MD
HAPPEL, CHRISTOPHER CHARLES,
MD
7/15/2011
8/29/2008
N0818
P1649
HASAN, SYED NAVED, MD
N5716
HAUN-HITA, DEANNA KAYE, MD
P7458
N1345
P4960
N0825
P1550
HAUPTMEIER, CHERIE LINAE, DO
HAYNES, JAMIE LYNN, MD
HAYS, AUGUSTA ELLICE, MD
HEATH, KARINA ANNELISE, MD
HENDRIX, JENNIFER ANN
KOVARIC, DO
N5104
P4456
HERNANDEZ, ARTURO , MD
HERRERA, ULYSSES , MD
7/15/2011
5/15/2013
Secondary Specialty
(Self-Designated)
FAMILY PRACTICE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
GERIATRICS
4/9/2010
2/5/2010
9/17/2012
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HINES
IL
GALVESTON
HEMPHILL
TX
TX
TX
HOUSTON
TX
FORT WORTH TX
GRAFTON
WI
SPORTS MEDICINE
(FAMILY PRACTICE)
Page 78 of 301
Registration
Status Date
Disciplinary
Status Date
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
ACTIVE
3/2/2012 None
N/A
ACTIVE
ACTIVE
1/19/2012 None
1/7/2013 None
N/A
N/A
ACTIVE
ACTIVE
7/20/2011 None
5/20/2013 None
N/A
N/A
12/17/2008 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
3/13/2012
12/10/2012
10/21/2009
12/6/2012
7/8/2013
8/20/2010
Disciplinary
Status of
Texas
License
8/1/2013
8/24/2011
4/27/2010
6/12/2012
None
None
None
None
N/A
N/A
N/A
N/A
7/15/2011 None
N/A
9/26/2008 None
N/A
WACO
TX
ACTIVE
MADISON
AL
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
12/19/2011 None
N/A
4/9/2010 None
N/A
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
12/7/2011 None
N/A
2/5/2010 None
10/23/2012 None
N/A
N/A
HOSPITALIST
8/1/2013
10/10/2008 10/10/2013 FAMILY MEDICINE
11/30/2012 11/30/2017 FAMILY MEDICINE
8/29/2008
12/1/2011
TX
TX
TX
TX
TX
TX
MCALLEN
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
SAN ANTONIO
WACO
SAN ANTONIO
EL PASO
KINGSLAND
DALLAS
NEUROLOGICAL
SURGERY
12/12/2008 12/12/2013 FAMILY MEDICINE
12/15/2011 12/15/2016 FAMILY MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LUBBOCK
TX
TRINITY
TX
PEKIN
IL
8/1/2013
10/31/2008
12/4/2012
9/22/2008
License
Number
P5379
N9065
Physician Name
HEVA-PATHTHINIGE, INDIKA
THARANGANIE, MD
HIGGS, SARAH KAY, MD
N6356
HOANG, TRACY TRAN, DO
edicaid
edicaid
End Date
Designated)
2/1/2013
3/15/2011
6/4/2010
P3000
P2459
HOFFARTH, KEVIN, MD
HORNER, JOHN GASTON, MD
5/1/2012
3/15/2012
N8664
P6187
HOWELL, LEE ANN, MD
HURT, MYERS ROBINSON III, MD
2/4/2011
4/12/2013
P5189
P3353
HUSSAIN, SHABBIR, MD
HUYNH, TAI T, MD
1/4/2013
6/1/2012
P7786
N8406
P6428
IBIDAPO-OBE, OYETOKUNBO, MD
ICHO, NANETTE ARIAYEFAH, MD
IGBOKWE, EBERENNE FRANCINE,
DO
8/30/2013
1/3/2011
5/1/2013
N6374
IGNATIUS, JASMIN ANN, DO
6/4/2010
N5120
IKBAL, KATRINY ANN, DO
2/5/2010
P2873
P5648
INGRAM, JELANI D, MD
IQBAL, ZOHA , MD
P4461
JACKSON, MASHEIKA SHONTAE,
DO
P3542
JAFRI, SYED RAZA ABBAS, MD
N9572
P1655
JEHAN, EFFAT, MD
JHA, MANIKA , MD
5/2/2011
12/15/2011 12/15/2016 FAMILY MEDICINE
N7930
JONES, CHRISTINA MARIE, DO
10/15/2010 10/15/2015 FAMILY MEDICINE
P2270
N8936
JOTWANI, VIJAY M, MD
JOYCE, REBECCA LYNNE, MD
4/13/2012
3/1/2013
9/17/2012
6/8/2012
3/1/2012
3/1/2011
Secondary Specialty
(Self-Designated)
Practice City
WACO
GENERAL
PREVENTIVE
MEDICINE
LAKEWAY
COLEMAN
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
6/4/2010 None
N/A
N/A
N/A
CEDARTOWN GA
GALVESTON TX
ACTIVE
ACTIVE
2/15/2011 None
4/22/2013 None
N/A
N/A
ACTIVE
ACTIVE
1/16/2013 None
6/25/2012 None
N/A
N/A
9/4/2013 None
1/6/2011 None
N/A
N/A
5/1/2013 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
4/17/2012 None
3/11/2013 None
N/A
N/A
11/16/2012 None
N/A
6/8/2012 None
N/A
5/2/2011 None
12/20/2011 None
N/A
N/A
10/15/2010 None
N/A
3/23/2012 None
3/11/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
TEXARKANA
TX
AR
ACTIVE
ACTIVE
FT. WORTH
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
EDCOUCH
Page 79 of 301
N/A
N/A
5/3/2012 None
3/20/2012 None
FAMILY PRACTICE
FAMILY
PRACTICE/OMM
SPORTS MEDICINE
(FAMILY PRACTICE)
2/1/2013 None
3/30/2011 None
ACTIVE
ACTIVE
SAN ANTONIO TX
GARLAND
TX
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Disciplinary
Status Date
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
INDIANAPOLIS IN
TEMPLE
TX
ACTIVE
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
P7655
P0417
P0611
JUNG, YEWAH, DO
JURDEN, LUCINDA ANN, MD
KABIR, JAHANGIR , MD
8/15/2013
7/15/2011
8/1/2011
N8800
2/15/2011
N7817
KALRA, MONICA GHOSH, DO
KANJEE, SHEETAL DELIPKUMAR,
MD
10/1/2010
N5758
KAPPLER, JULIE ELIZABETH, MD
4/9/2010
P0741
KASHANI, NASSER , MD
8/15/2011
FAMILY PRACTICE
EMERGENCY
MEDICINE
N6416
KENNEDY, SARAH LYNN, DO
6/4/2010
FAMILY PRACTICE
P1658
N1362
KERR, CHRISTY LYNN, MD
KEY, MARK RICHARD, MD
N9239
P2278
KHAN, AMEER ASIF, MD
KHAN, HENA ZAFAR, MD
N4518
KHAN, TANIA, MD
P4662
KHIRI, EMAN, MD
N7292
P0617
KHOSHNEJAD, MANI , MD
KIDANE, ALISHA KITHCART, MD
N8114
P4469
KIDD, LUCINA AVILA, DO
KIM, GRACE WEN, MD
P7485
KING, JAMES DONAVON II, MD
N8531
N7823
KING, STEPHEN PAUL, MD
KINGCAID, EVETTE , MD
N6425
KIRKWOOD, TOBY CARTER, DO
KOHLLEPPEL, SHELLEY RENEE,
MD
KONOPACKI, MICHAEL STUART,
MD
N3120
P1341
KINGWOOD
HOUSTON
GERIATRICS
12/15/2011 12/15/2016 FAMILY MEDICINE
10/10/2008 10/10/2013 FAMILY MEDICINE
4/1/2011
3/1/2012
11/6/2009
10/15/2012 10/15/2017 FAMILY MEDICINE
8/2/2010
8/1/2011
11/15/2010 11/15/2015 FAMILY MEDICINE
9/17/2012
8/1/2013
1/18/2011
10/1/2010
6/4/2010
5/29/2009
11/4/2011
Practice City
HOSPITALIST
URGENT CARE
MEDICINE
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS
FAMILY
PRACTICE/OMM
SPORTS MEDICINE
(FAMILY PRACTICE)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
SAN ANTONIO TX
STEPHENVILL
E
LUBBOCK
LAKE
CHARLES
GROTON
WICHITA
FALLS
Disciplinary
Status Date
8/15/2013 None
8/1/2011 None
8/19/2011 None
N/A
N/A
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
10/13/2010 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/18/2011 None
N/A
6/4/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
12/19/2011 None
10/23/2008 None
N/A
N/A
LA
CT
ACTIVE
ACTIVE
4/6/2011 None
3/6/2012 None
N/A
N/A
TX
ACTIVE
12/7/2009 None
N/A
10/23/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/2/2010 None
8/5/2011 None
N/A
N/A
FORT BLISS
HOUSTON
TX
TX
ACTIVE
ACTIVE
1/11/2011 None
9/20/2012 None
N/A
N/A
BRYAN
TX
8/22/2013 None
N/A
MILWAUKEE
WI
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
1/18/2011 None
10/11/2010 None
N/A
N/A
6/4/2010 None
N/A
6/4/2009 None
N/A
11/4/2011 None
N/A
FORT WORTH TX
Page 80 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
License
Number
P1342
P1557
P4588
P2711
Physician Name
KOSARAC, BRANKA , MD
KOVOOR, JOHNNY GEORGE, MD
KUMAR, UMESH, MD
KUMAR-FLORES, JESSICA, MD
N6443
P4667
N2157
KURZ, MICHAEL WAYNE, MD
KUSEMIJU, OLADIPO AJOSE, MD
LANDEN, DONNA AKANE, MD
N8207
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
11/4/2011
12/1/2011
10/1/2012
HOSPITALIST
4/2/2012
FAMILY PRACTICE 6/4/2010
EMERGENCY MED
10/15/2012 10/15/2017 FAMILY MEDICINE
2/6/2009
12/1/2010
5/15/2012
P6209
N4544
LARSON, KELLY SUZANNE, MD
LATTA, TAMIKA DANIELLE
SHAUNTA, MD
LAZARINI, JONATHAN ALEXANDER,
MD
LE, RICHARD TAN, DO
4/12/2013
11/6/2009
N3823
P4477
LEFFLER, BRIAN JAMES, MD
LEGARDA, EUGENIA , MD
8/21/2009
9/17/2012
P0756
LINCOLN, JEWEL CATHERINE, DO
8/15/2011
N5194
2/5/2010
N7131
LINDEMANN, CAREY JYNETTE, MD
LITCHFIELD, CHRISTOPHER
TERRENCE, MD
7/15/2010
P1781
LITTLE, KATHRYN ELIZABETH, MD
1/2/2012
N5817
4/9/2010
N7715
LOMBANA-MARTINEZ, CLARA I, MD
LOMBOY, JUANITO QUINONES JR,
MD
9/15/2010
N7830
LONGE, UCHEOMA NEBECHI, MD
10/1/2010
N8028
LOONEY, WARREN HUNTER, MD
N9733
LOTT, NOAH THOMAS, MD
5/16/2011
P5287
LOZANO, KRISTINA MARIE, MD
LUCERO-UGALINO, LULITA
TAGUBA, MD
LUNA, JEFFREY LEE, MD
1/15/2013
P3188
P5546
P5103
10/29/2010 10/29/2015 FAMILY MEDICINE
2/8/2013
12/17/2012 12/17/2017 FAMILY MEDICINE
Practice City
GALVESTON
YONKERS
SARTELL
PICAYUNE
CORPUS
CHRISTI
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
NY
ACTIVE
ACTIVE
MN
ACTIVE
LICENSE
ISSUED
MS
ACTIVE
ACTIVE
TX
FAMILY PRACTICE
SPORTS MEDICINE
(FAMILY PRACTICE)
OBSTETRICS
Page 81 of 301
Disciplinary
Status Date
N/A
N/A
N/A
N/A
6/4/2010 None
12/21/2012 None
3/2/2009 None
N/A
N/A
N/A
1/18/2011 None
N/A
5/15/2012 None
N/A
4/29/2013 None
11/24/2009 None
N/A
N/A
FORT WORTH TX
FORT WORTH TX
ACTIVE
ACTIVE
PLAINVIEW
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
8/28/2009 None
9/19/2012 None
N/A
N/A
8/15/2011 None
N/A
2/5/2010 None
N/A
7/15/2010 None
N/A
ACTIVE
1/12/2012 None
N/A
ACTIVE
LICENSE
ISSUED
4/26/2010 None
N/A
9/15/2010 None
N/A
TX
FAMILY PRACTICE
FAMILY PRACTICE
ADDICTION
MEDICINE - FP
ACTIVE
LICENSE
ISSUED
Registration
Status Date
11/10/2011
12/5/2011
10/5/2012
4/16/2012
Disciplinary
Status of
Texas
License
None
None
None
None
HOUSTON
TX
ACTIVE
10/7/2010 None
N/A
BAYTOWN
COLLEGE
STATION
LACKLAND
AFB
TX
ACTIVE
11/3/2010 None
N/A
TX
ACTIVE
6/6/2011 None
N/A
TX
ACTIVE
2/4/2013 None
N/A
MISHAWAKA IN
FORT WORTH TX
ACTIVE
ACTIVE
2/18/2013 None
12/20/2012 None
N/A
N/A
License
Number
Physician Name
P5103
P5103
Medicare/M
edicaid
Agreement
Start Date
12/17/2012
12/17/2012
Medicare/M
edicaid
Agreement Primary Specialty (SelfEnd Date
Designated)
P7802
LUNG, JOHN, MD
8/30/2013
N4567
MAGNO, FERDINAND LYNDON, MD
11/6/2009
N9899
P3195
MAKIA, AYUK, MD
MALAVE, SAMANTHA D, MD
6/3/2011
5/15/2012
P0432
MALBAS, ANTONIO CABRERA, MD
7/15/2011
N7836
P0995
P1100
MALHOTRA, MINNI, MD
MALIYIL, JEPSIN ANAT, MD
MALL, SANJEEV KUMAR, MD
10/1/2010
9/15/2011
10/3/2011
N7456
MALPANI, VISHAL BHAGCHAND,
MD
8/16/2010
P3647
P0633
MANKIN, SARAH ASHLEY, DO
MARANCENBAUM, ARIE , MD
6/15/2012
8/1/2011
P2728
MARCUM, BENJAMIN AUSTIN, MD
4/2/2012
P0436
P1895
P4887
MAREN, CHRISTINE , DO
MARQUART, PRECIOUS JEWEL,
MD
MARTIN, LANCE STEVEN, MD
MARTINEZ GAMBA, GERMAN
NICOLAS, MD
MARTINEZ, RAUL SOSA, MD
MARTINEZ-MADRIGAL, EZEQUIEL,
MD
MATAOUI, NOHA, MD
N8217
MATHESON, THOMAS BLAIR, MD
N1389
P5551
P5680
N7945
7/15/2011
10/10/2008 10/10/2013 FAMILY MEDICINE
2/8/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
Practice City
State
License
FORT WORTH TX
ACTIVE
FORT WORTH TX
ACTIVE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
LICENSE
ISSUED
SAN BENITO
TX
DICKINSON
CORPUS
CHRISTI
TX
TX
FAMILY PRACTICE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
OSTEO
MANIPULATIVE
MEDICINE
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
12/17/2009 None
N/A
6/3/2011 None
5/22/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/11/2011 None
N/A
10/1/2010 None
10/28/2011 None
10/14/2011 None
N/A
N/A
N/A
9/2/2010 None
N/A
TEMPLE
TX
ACTIVE
LUBBOCK
BAYTOWN
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
6/18/2012 None
8/19/2011 None
N/A
N/A
4/2/2012 None
N/A
SAN ANTONIO TX
ACTIVE
7/20/2011 None
N/A
FAMILY MEDICINE
BURLESON
LUBBOCK
ACTIVE
ACTIVE
10/31/2008 None
2/14/2013 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
3/6/2013 None
10/21/2010 None
N/A
N/A
1/17/2012 None
11/29/2012 None
N/A
N/A
12/6/2010 None
N/A
TX
TX
SAN ANTONIO TX
1/17/2012
11/15/2012 11/15/2017 FAMILY MEDICINE
8/30/2013 None
FP/OSTEO
MANIPULATION
MEDICINE
3/1/2013
10/15/2010 10/15/2015 FAMILY MEDICINE
12/1/2010
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/20/2012 None
N/A
12/20/2012 None
N/A
GENERAL SURGERY BISMARCK
Page 82 of 301
ND
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N4577
N5850
MATHEWS, REENA RACHEL, MD
MAZHAR, DANISH, MD
11/6/2009
4/9/2010
N3879
MBA, FARLEY ESIGFEI, MD
8/21/2009
N5856
MCFADDEN, MELISSA JEAN, DO
4/9/2010
N8420
P6869
P7509
N5861
1/3/2011
6/3/2013
8/1/2013
4/9/2010
1/3/2016
6/3/2018
8/1/2018
4/9/2015
P0443
MCKINNEY, MELISSA ANN, DO
MEDINA, DIANA , MD
MELNITSKY, HANNAH , MD
MENARD, JAMES RYAN, MD
MERCADO, CLAUDIA GETZABETH,
MD
7/15/2011
N8221
MERCADO, THOMAS MICHAEL, MD
N4587
Secondary Specialty
(Self-Designated)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
FAMILY MEDICINE
EMERGENCY
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
FORT WORTH TX
HUMBLE
TX
ACTIVE
ACTIVE
AMARILLO
HOSUTON
TX
FORT WORTH TX
TYLER
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
1/3/2011
6/27/2013
8/15/2013
4/26/2010
None
None
None
None
N/A
N/A
N/A
N/A
LAREDO
TX
ACTIVE
7/21/2011 None
N/A
12/1/2010
AMARILLO
TX
ACTIVE
N/A
MICHEL, YENNI LILLIA, DO
11/6/2009
DEL VALLE
TX
P2301
N3888
P5557
N2662
N0981
P4484
MIER Y TERAN, JOSE LUIS, MD
MIKESKA, HEATHER ANN, MD
MILLENDER, KAREN LOUISE, MD
MILLER, DILLON DERRICK, MD
MINA, EMAN GAMIL-FAHIM, MD
MIR, TASADUQ HUSSAIN, MD
3/1/2012
8/21/2009
2/8/2013
4/3/2009
8/29/2008
9/17/2012
3/1/2017
8/21/2014
2/8/2018
4/3/2014
8/29/2013
9/17/2017
LA GRANGE
TX
3/1/2012
8/28/2009
2/12/2013
5/5/2009
9/8/2008
10/1/2012
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N7147
MIWA, EDWARD ALEJANDRO, MD
7/15/2010
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
12/8/2010 None
SEE
PREVIOUS
12/3/2009 ORDER
7/15/2010 None
N/A
8/16/2013 None
N/A
4/8/2011 None
N/A
ACTIVE
7/19/2010 None
N/A
FORT WORTH TX
SAN ANTONIO TX
ACTIVE
ACTIVE
3/4/2013 None
9/2/2013 None
N/A
N/A
DALLAS
ACTIVE
11/28/2011 None
N/A
P7674
MOHAMMED, ANWARULLAH , MD
8/15/2013
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY
PRACTICE/OMM
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
UVALDE
TX
SAN ANTONIO TX
DALLAS
TX
FAMILY PRACTICE
WICHITA
FALLS
N9389
MONROY, ANWAR EDUARDO, MD
4/8/2011
N7149
MONTOYA, MELISSA MARINA, MD
7/15/2010
P5690
P7816
MOON, MIA KWUN, MD
MORGAN, RUTH, MD
3/1/2013
8/30/2013
P1366
MORGAN, SHERRI LYNN, MD
11/4/2011
TX
TX
GERIATRIC
MEDICINE (INTERNAL
MED)
PHARMACEUTICAL
MEDICINE
OBSTETRICS AND
GYNECOLOGY
Page 83 of 301
ACTIVE
LICENSE
ISSUED
TX
11/12/2009 None
4/14/2010 None
N/A
N/A
9/2/2009 None
N/A
4/9/2010 None
N/A
8/24/2009
License
Number
Physician Name
N1504
MORRIS, TRICIA JUDITH, MD
N3910
J9528
MORRISON, CHRISTOPHER
ANDREW, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
12/12/2008 12/12/2013 FAMILY MEDICINE
FAMILY PRACTICE
UNDERSEA AND
HYPERBARIC MED
8/21/2009
(PREV MED)
12/12/2008 12/12/2013 FAMILY MEDICINE
P1368
MORSCH, JAMES KYLE, MD
MOSCOSO AGOSTO, ALEJANDRA,
MD
P0449
N2203
P2310
P0916
H2632
N3917
P4895
MUGHAL, MOHAMMAD ANSAR, MD
MUJAHID, AMBREEN , MD
MUJURUKI, CEPHAS , MD
MULLICAN, DAVID RYAN, MD
MULVEHILL, SHARON ANN, MD
MUMTAZ, MEHNAZ , MD
MUZAFFAR, SUMERA, MD
7/15/2011
7/15/2016
2/6/2009
2/6/2014
3/1/2012
3/1/2017
9/1/2011
9/1/2016
5/15/2013
5/15/2018
8/21/2009
8/21/2014
11/15/2012 11/15/2017
P4684
P2741
N8959
P1113
P0451
NAHAR, RIADUN , MD
NAKIB, EVAN ZEB, MD
NANGHA, PANNABEN, MD
NAQVI, ALI HASNAIN, MD
NASREEN, JOHRA, MD
NDUKWE, STELLA ADA-IHUOMA,
MD
10/15/2012 10/15/2017 FAMILY MEDICINE
4/2/2012
3/1/2011
10/3/2011
7/15/2011
P7520
11/4/2011
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
8/1/2013
11/6/2009
N1014
N4616
N8961
N3943
P1116
NELSON, BRIAN SHAWN, MD
NEMARUGOMMULA, NANDA
KISHORE , MD
NGUYEN, ANH TAT, MD
NGUYEN, BICH-MAY, MD
NGUYEN, GIANG LE , MD
NGUYEN, HANH NGOC, DO
8/29/2008
11/6/2009
3/1/2011
8/21/2009
10/3/2011
8/29/2013
11/6/2014
3/1/2016
8/21/2014
10/3/2016
P7822
NGUYEN, STEVEN XUAN, MD
8/30/2013
P7823
P1117
P0860
P6689
NGUYEN, THI THANH, DO
NGUYEN, VINH QUANG, MD
NIELAND, MELISSA JANE, MD
NISHAT, ARIFA, MD
NUNEZ URIBURU, HUMBERTO
FERNANDO, MD
8/30/2013
10/3/2011
8/26/2011
5/15/2013
8/30/2018
10/3/2016
8/26/2016
5/15/2018
8/29/2008
N4614
N1022
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
Practice City
DALLAS
TIERRA
VERDE
COPPERAS
COVE
OBSTETRICS
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/28/2009 None
N/A
FL
ACTIVE
9/11/2009 None
N/A
TX
ACTIVE
2/4/2009 None
N/A
TX
ACTIVE
11/7/2011 None
N/A
SAN ANTONIO TX
MIDAND
TX
AMARILLO
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
8/11/2011
3/10/2009
3/19/2012
9/7/2011
7/8/2013
10/29/2009
11/20/2012
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
12/10/2012
4/12/2012
4/20/2011
10/13/2011
8/8/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
DALLAS
FAMILY PRACTICE
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
BILLINGS
MT
SAN ANTONIO TX
FAMILY MEDICINE
WICHITA
FALLS
MONROE
WORCESTER
AMARILLO
SAN ANTONIO
TX
LA
MA
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
FAMILY MEDICINE
EMERGENCY
MEDICINE
OTOLOGY/NEUTOTO
LOGY
FAMILY MEDICINE
PASADENA
TX
ACTIVE
8/8/2013 None
N/A
EDEN
TX
ACTIVE
11/17/2009 None
N/A
FLORESVILLE TX
IRVING
TX
OTOLARYNGOLOGY
FAMILY PRACTICE
FAMILY
PRACTICE/OMM
HUMBLE
WACO
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
11/27/2008
11/19/2009
3/15/2011
9/15/2009
10/19/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
LAFAYETTE
LA
9/2/2013 None
N/A
SUGAR LAND
BELTON
CALHOUN
TX
TX
LA
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
MISSION
TX
ACTIVE
HOSPITALIST
HOSPITALIST
Page 84 of 301
8/30/2013
10/25/2011
8/31/2011
6/4/2013
None
None
None
None
N/A
N/A
N/A
N/A
9/26/2008 None
N/A
License
Number
Physician Name
N5913
NUNLEY, AMANDA WITT, MD
N8329
P2906
N1026
NWAGBATA, EBELECHUKWU, MD
NWANEGBO, EDWARD CHIEKE,
MD
OBREGON, JACINTO AMARU, MD
P7525
P7526
edicaid
edicaid
End Date
Designated)
4/9/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
12/15/2010 12/15/2015 FAMILY MEDICINE
4/13/2012
8/29/2008
ODUMOSU, OLUTONI , MD
8/1/2013
8/1/2013
P1204
OGBOGU, KENE, MD
OGUNTUGA, OLUSESAN ABIODUN,
MD
N6547
OKEA, REMIGIUS NWABUEZE, MD
6/4/2010
P4604
OKIN, ABIODUN ADEJUMOKE, MD
10/1/2012
P7324
OKORO, NOSAKHARE , MD
7/15/2013
P7173
OKORODUDU, JANAI MARLIS, MD
OLUBANJO, OLUGBEMINIYI
IBIDAPO, MD
10/17/2011 10/17/2016 FAMILY MEDICINE
EAST
LANSING
EL PASO
Disciplinary
Status Date
4/9/2010 None
N/A
ACTIVE
1/17/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/24/2012 None
10/8/2008 None
N/A
N/A
8/1/2013 None
N/A
8/8/2013 None
N/A
ST LOUIS
PARK
MN
ACTIVE
PAWHUSKA
OK
ACTIVE
LICENSE
ISSUED
10/25/2011 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
10/16/2012 None
N/A
ODESSA
WICHITA
FALLS
TX
ACTIVE
7/22/2013 None
N/A
7/1/2013
DALLAS
TX
ACTIVE
8/14/2013 None
N/A
8/29/2008
FORT WORTH TX
ACTIVE
9/15/2008 None
N/A
7/15/2011
GENERAL PRACTICE HOUSTON
TX
ACTIVE
7/20/2011 None
N/A
P7686
ORDONEZ, ADOLFO JOSE, MD
ORUE QUINTANA, VALERIA
ALEJANDRA, MD
8/15/2013
HOUSTON
TX
ACTIVE
8/19/2013 None
N/A
N4641
OSAYANDE, AMIMI SANDRA , MD
11/6/2009
DALLAS
TX
ACTIVE
11/16/2009 None
N/A
N3967
OSUJI, NONYEREM NNENNA , MD
8/21/2009
SAN ANTONIO TX
ACTIVE
8/31/2009 None
N/A
N3221
OTTNEY, MICHAEL DAVID, DO
5/29/2009
PARIS
IL
ACTIVE
1/4/2010 None
N/A
N9619
N7320
OYIRIARU, DANIEL IKECHUKWU,
MD
OZA, VIJAY CHANDULAL, MD
5/2/2011
8/2/2010
AUSTIN
TX
ACTIVE
ACTIVE
5/19/2011 None
8/18/2010 None
N/A
N/A
P5220
PANDEY, MANJU KHATIWADA, MD
1/4/2013
LEWISVILLE
TX
ACTIVE
2/28/2013 None
N/A
P0463
PARETS-RODRIGUEZ, LISSET , MD
7/15/2011
ACTIVE
8/24/2011 None
N/A
N1033
P0460
FAMILY PRACTICE
MI
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
EMERGENCY
MEDICINE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
FAMILY PRACTICE
Page 85 of 301
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N7737
PARKER, CLEVIS TYRONE SR, MD
9/15/2010
P7180
PATEL, AFSHEEN ABDULLAH, MD
7/1/2013
N1049
P2334
P7328
P0115
N6958
PATEL, RAJESH , MD
PATERNINA, JESUS DAVID, MD
PATIL, PUNAM MAHENDRA, MD
PATRINELY, PATRICIA HALL, DO
PATTERSON, JOHN , MD
8/29/2008
3/1/2012
7/15/2013
6/15/2011
7/1/2010
P6500
PEREZ, KARLA ALEJANDRA, MD
5/1/2013
N4666
P4995
P1680
PHAM, CYNTHIA ANNE, DO
PHAN, NGOC KHANH THI, DO
PILLI, PRASAD JOHNSON RAJU,
MD
PILLI, SUJA PERAKATHU, MD
PIMENTEL, SACRAMENTO, MD
PINO, JONATHAN WILLIAM, MD
PINTO, MAURICIO , MD
POGOSIAN, ELENA GRIGOREVNA,
MD
P1918
N7329
N7330
PORR, JENNIFER REHM, MD
PRICE, ERIC WILLIAM, MD
PRUNA, ERNESTO, MD
P3566
P0470
P1915
N4671
P4799
8/29/2013
3/1/2017
7/15/2018
6/15/2016
7/1/2015
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
11/6/2009
11/30/2012 11/30/2017 FAMILY MEDICINE
6/8/2012
7/15/2011
1/17/2012
11/6/2009
11/1/2012
6/8/2017
7/15/2016
1/17/2017
11/6/2014
11/1/2017
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
12/15/2011 12/15/2016 FAMILY MEDICINE
1/17/2012
8/2/2010
8/2/2010
FAMILY MEDICINE
OBSTETRICS
FAMILY
PRACTICE/OMM
HOSPITALIST
PALLIATIVE
MEDICINE
N1080
PUCKETT, FREDRIC CLARK, DO
8/29/2008
N8837
N4012
N4016
PURI, RAHUL DINESH, MD
QUINTANA, MAX E, MD
RAFOLS, RAFAEL JOSE, MD
2/15/2011
8/21/2009
8/21/2009
N5345
RAHIMI, ABDULWALI SAMAD, MD
2/5/2010
N5958
P4698
RAJA, MANISHA, MD
RAJAN, JESSEN ANN, MD
N8448
RAMAS, MARIE-ELIZABETH , MD
4/9/2010
10/15/2012 10/15/2017 FAMILY MEDICINE
1/3/2011
Secondary Specialty
(Self-Designated)
PALLIATIVE
MEDICINE
FAMILY
PRACTICE/OMM
HOSPITALIST
EMERGENCY
MEDICINE
GERIATRICS
FAMILY PRACTICE
Page 86 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
BIG LAKE
TX
ACTIVE
9/22/2010 None
N/A
COLUMBIA
MO
ACTIVE
7/15/2013 None
N/A
FT. BLISS
MCALLEN
TX
TX
CONROE
EL PASO
CORPUS
CHRISTI
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/30/2008
3/28/2012
7/23/2013
6/20/2011
7/22/2010
TX
ACTIVE
N/A
EASTPOINTE
HOUSTON
MI
TX
ACTIVE
ACTIVE
5/13/2013 None
SEE
PREVIOUS
11/18/2009 ORDER
12/4/2012 None
HARLINGEN
HARLINGEN
BURLINGTON
HENRIETTA
TX
TX
CO
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/11/2012
7/20/2011
1/26/2012
11/13/2009
11/12/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
12/22/2011 None
N/A
1/17/2012 None
9/16/2010 None
8/6/2010 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
10/2/2008 None
N/A
2/15/2011 None
10/12/2009 None
8/31/2009 None
N/A
N/A
N/A
2/5/2010 None
N/A
4/9/2010 None
11/19/2012 None
N/A
N/A
1/3/2011 None
N/A
SAN ANTONIO TX
DALLAS
TX
ENNIS
TX
AUSTIN
MCALLEN
TX
TX
CONROE
TX
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
11/9/2009
N/A
License
Number
Physician Name
N7743
RAMOS, DAVID ANTHONY, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
9/15/2010
FAMILY MEDICINE
N6598
P2054
P0474
P6896
P7022
P2160
N7335
P7697
RANA, SHITAL MANOHAR, MD
RANE, POONAM N, MD
RAO, SILPA, MD
RAY, JOHN KINDLEY, MD
RAY, KATIE LAEL KUCERA, MD
REDDY, PRASHANT , DO
RICHMOND, TERIYA MONICK, MD
RILEY, MARISTELLA, MD
6/4/2010
2/1/2012
7/15/2011
6/3/2013
6/14/2013
2/10/2012
8/2/2010
8/15/2013
6/4/2015
2/1/2017
7/15/2016
6/3/2018
6/14/2018
2/10/2017
8/2/2015
8/15/2018
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
P6256
P0481
4/12/2013
7/15/2011
N4707
RINGLER, ROBERT LLOYD JR, MD
RODE, RASHMI, MD
RODNEY, JOHN ROCCO
MACMILLAN, MD
11/6/2009
P1134
RODRIGUEZ, ANA VERONICA, MD
10/3/2011
P0870
RODRIGUEZ, JOSE ANTONIO, MD
8/26/2011
N9772
P6069
5/16/2011
4/1/2013
N1433
N1868
ROGERS, GREGORY B, MD
ROLDAN, GUADALUPE , MD
ROOPIREDDY, SREEKANTH
REDDY, MD
ROSERO, RAMIRO RENE, MD
P7198
RUALES, STEPHANIE RODIS, MD
7/1/2013
N5375
RUIZ, ALBERTO , MD
2/5/2010
N2270
P5568
RUIZ, PETER ANTHONY, MD
RUSSELL, MICHAEL ADAM, DO
P2163
SADOUN, ELISE YASMEEN, MD
SALCEDO, EVA SAMELLA
SALVACION, MD
SALCIDO, ARMANDO JR, MD
SALEEM, SADAF, MD
SALINAS MALDONADO, OSCAR ,
MD
N4057
P3666
P2515
N5990
FAMILY PRACTICE
Registration
Status of
Practice
Texas
Practice City
State
License
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
ACTIVE
RICHMOND
TX
ACTIVE
ALPINE
TX
ACTIVE
MARFA
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
CEDAR PARK
HOUSTON
None
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
4/17/2013 None
7/21/2011 None
N/A
N/A
FORT WORTH TX
ACTIVE
11/16/2009 None
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
10/6/2011 None
N/A
8/26/2011 None
N/A
5/16/2011 None
4/15/2013 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/16/2008 None
2/2/2009 None
N/A
N/A
7/1/2013 None
N/A
2/5/2010 None
N/A
TX
LOCKHART
LAKEWOOD
TX
CA
MUNCIE
IN
CORPUS
CHRISTI
AUSTIN
2/6/2009
2/8/2013
2/10/2012
8/21/2009
6/15/2012
3/15/2012
HOUSTON
AMARILLO
4/9/2010
EDINBURG
Page 87 of 301
6/4/2010
2/6/2012
7/25/2011
6/7/2013
6/20/2013
2/15/2012
9/20/2010
8/19/2013
TX
TX
SPORTS MEDICINE
(FAMILY PRACTICE)
10/10/2008 10/10/2013 FAMILY MEDICINE
12/12/2008 12/12/2013 FAMILY MEDICINE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
10/5/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
N/A
N/A
LICENSE
ISSUED
3/9/2009 None
2/21/2013 None
SEE
PREVIOUS
2/10/2012 ORDER
TX
TX
ACTIVE
ACTIVE
ACTIVE
9/1/2009 None
6/27/2012 None
3/29/2012 None
N/A
N/A
N/A
TX
ACTIVE
4/19/2010 None
N/A
2/13/2012
License
Number
P3434
P4706
P4905
J8364
P7200
N3290
P5468
N6987
Physician Name
SALINAS, MARIELA , MD
SALVI, SAMBHITAB SUNIL, MD
SAM, SIBY , MD
SANTOS, JOSE SALVADOR, MD
SARAO, RAVJOT SINGH, MD
SATISH, NISHA , MD
SAYANI, JAIRAJ, MD
SCHOCHLER, AMY LEANN, DO
N3296
N4734
SCIRTO, KIRK ANTHONY , MD
SEMONES, KAREN L , MD
N6649
P5722
N6650
P3447
N6013
Medicare/M
edicaid
Agreement
Start Date
6/1/2012
10/15/2012
11/15/2012
4/2/2012
7/1/2013
5/29/2009
2/1/2013
7/1/2010
Medicare/M
edicaid
Agreement
End Date
6/1/2017
10/15/2017
11/15/2017
4/2/2017
7/1/2018
5/29/2014
2/1/2018
7/1/2015
Primary Specialty (Self- Secondary Specialty
Designated)
(Self-Designated)
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
HOSPITALIST
FAMILY MEDICINE
FAMILY MEDICINE
HOSPITALIST
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
5/29/2009
11/6/2009
SEYMOUR, ELIZABETH RUTH, MD
SHAFIE, EL SHERIF OMAR, MD
6/4/2010
3/1/2013
6/4/2010
6/1/2012
4/9/2010
N7875
SHAFIK, MARK SALEH, MD
SHAH, NAYNA VISHAL, MD
SHARMA, ISHITA, MD
SHERRILL, JULIA KRISTINA
CATHERINE, MD
10/1/2010
N6021
N6999
SHIVES, JASON LEE, MD
SHOETAN, CHARLES, MD
4/9/2010
7/1/2010
P7035
SIDDIQUE, MUHAMMAD TALAL, MD
6/14/2013
N5400
N4104
K7481
2/5/2010
8/21/2009
9/1/2011
P4716
SIDHU, ANUPAM KAY, MD
SIMONS, NATHAN TREVOR, MD
SINGH, SVETA, DO
SISTA, SATHYADEVI
RAJYALAKSHMI, MD
P5004
N1456
SMELTER, PAUL JOHN, MD
SMITH, TAWANA LAKESHA, MD
P2066
N7879
SOBREVILLA, JOSE RICARDO, MD
SOLOMON, SABRINA ANN, MD
N1460
SPROCKEL, PETER TIMOTHY, MD
Registration
Status of
Practice
Texas
Practice City
State
License
SAN ANTONIO TX
ACTIVE
ABILENE
TX
ACTIVE
ACTIVE
SUNRISE
FL
ACTIVE
SAN ANTONIO TX
ACTIVE
DALLAS
TX
ACTIVE
FREMONT
OH
ACTIVE
OROFINO
ID
ACTIVE
DELINQUEN
T-NON
PAYMENT
OLYMPIA
WA
ACTIVE
LICENSE
ISSUED
SUGAR LAND TX
ACTIVE
LICENSE
ISSUED
URBANA
IL
ACTIVE
ALEXANDRIA LA
ACTIVE
Registration
Status Date
6/29/2012
10/19/2012
11/27/2012
4/5/2012
8/23/2013
6/12/2009
2/15/2013
7/5/2010
Disciplinary
Status of
Texas
License
None
None
None
None
None
None
None
None
Disciplinary
Status Date
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
8/27/2009 None
11/19/2009 None
N/A
N/A
6/4/2010 None
3/21/2013 None
N/A
N/A
6/4/2010 None
6/11/2012 None
4/29/2010 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
10/12/2010 None
N/A
4/9/2010 None
7/19/2010 None
N/A
N/A
7/10/2013 None
N/A
BRENHAM
TX
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
2/5/2010 None
8/26/2009 None
11/30/2011 None
N/A
N/A
N/A
10/15/2012 10/15/2017 FAMILY MEDICINE
SUGARLAND
TX
ACTIVE
N/A
11/30/2012 11/30/2017 FAMILY MEDICINE
10/10/2008 10/10/2013 FAMILY MEDICINE
SPRINGFIELD IL
TEXAS CITY
TX
ACTIVE
ACTIVE
1/9/2013 None
SEE
PREVIOUS
12/10/2012 ORDER
1/2/2009 None
MCALLEN
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
2/6/2012 None
10/11/2010 None
N/A
N/A
LUBBOCK
ACTIVE
10/21/2008 None
N/A
2/1/2012
10/1/2010
HOSPITALIST
FAMILY PRACTICE
OBSTETRICS
HOSPITALIST
10/10/2008 10/10/2013 FAMILY MEDICINE
Page 88 of 301
SUGARLAND
TX
LUBBOCK
TX
TX
12/3/2012
N/A
License
Number
Physician Name
P2535
SQUYRES, JUSTIN DAYLE, MD
P7713
STEFFY, DANIEL ANTHONY, MD
N6041
STEIER, JAMES MAURICE, MD
P1414
N4137
STELL, CASEY NICOLE, DO
STUDENY, SIMON , MD
P6094
N9650
SUBRAMANIAM, HAMSA, MD
SUNDERMEYER, RICHARD LEVI III,
MD
P3458
P4517
edicaid
edicaid
End Date
Designated)
3/15/2012
8/15/2013
4/9/2010
11/4/2011
8/21/2009
4/1/2013
5/2/2011
SUNG, ANGIE C, MD
SYED, ZUBAIR AHMED, MD
6/1/2012
9/17/2012
N8733
SYEDA, SARA JABEEN, MD
2/4/2011
N1467
P6732
P2378
N8066
TA, NAHN , MD
TABE, JULIUS, MD
TAMEEZ, IFFAT, MD
TAN, CRISTIANE CAMPOS, MD
P3592
6/8/2012
N7754
TATAH, ANDREW BAMNJO, MD
TECSON, SHEILA LIBERTY DE
CASTRO, MD
9/15/2010
P0506
TENG, EDWARD CHAO HUNG, MD
7/15/2011
N1177
TENNYSON, TYRA DAREECE, MD
8/29/2008
P1827
P1238
P2169
TERRY, AARON WADE, MD
THAROO, ANAM REHMAN, MD
TOLEDO, CLAUDIO CONSTANTINO,
MD
N7185
P0680
P7584
N4805
10/10/2008 10/10/2013 FAMILY MEDICINE
5/15/2013
3/1/2012
10/29/2010 10/29/2015 FAMILY MEDICINE
Secondary Specialty
(Self-Designated)
FAMILY MEDICINE
FORT WORTH TX
TOMSIC, KEVIN LEE, MD
TOOR, NADIA NAEEM, MD
TRAN, TUNG MINH BA, MD
7/15/2010
8/1/2011
8/1/2013
TREVINO, EDGAR ALBERTO, MD
11/6/2009
DALLAS
TX
LAWTON
FORTH
WORTH
OK
AMARILLO
TX
TX
FAMILY PRACTICE
Page 89 of 301
N/A
N/A
4/8/2013 None
N/A
5/16/2011 None
N/A
6/1/2012 None
10/4/2012 None
N/A
N/A
2/4/2011 None
N/A
6/8/2012 None
N/A
ACTIVE
9/20/2010 None
N/A
AR
ACTIVE
8/1/2011 None
N/A
NC
ACTIVE
9/22/2008 None
N/A
TX
ACTIVE
ACTIVE
1/26/2012 None
10/27/2011 None
N/A
N/A
BULVERDE
TX
NACOGDOCH
ES
TX
ACTIVE
2/17/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
7/27/2010 None
8/29/2011 None
8/8/2013 None
SEE
PREVIOUS
11/6/2009 ORDER
N/A
N/A
N/A
TEXARKANA
CAMP
LEJEUNE
RANDOLPH
AFB
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
11/4/2011 None
8/27/2009 None
N/A
N/A
N/A
N/A
CONROE
SPORTS MEDICINE
(FAMILY PRACTICE)
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/19/2012 None
N/A
8/21/2013 None
N/A
4/26/2010 None
N/A
None
None
None
None
HOSPITALIST
FAMILY MEDICINE
1/2/2012
10/17/2011 10/17/2016 FAMILY MEDICINE
2/10/2012
Registration
Status of
Practice
Texas
Practice City
State
License
FORT WORTH TX
ACTIVE
AUSTIN
TX
ACTIVE
OMAHA
NE
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
REDWOOD
VALLEY
CA
ACTIVE
LICENSE
ISSUED
11/17/2008
6/4/2013
3/12/2012
11/3/2010
11/9/2009
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P7585
P2549
TREVINO-RAMIREZ, KARLA , MD
TROTTA, ADAM LEVI, MD
8/1/2013
3/15/2012
P6291
TURNER, AMANDA SUE, MD
4/12/2013
P7365
TYO, STEPHANIE RENEE, MD
7/15/2013
N6738
N4816
URREA-BOTERO, GABRIEL
ALBERTO, MD
USHER, ELENITA LORENI, MD
N9144
6/4/2010
11/6/2009
3/15/2011
N7368
N1486
UZOWULU, OBINNA CHIMEZIE, MD
VALLEJO-NIETO, MARIA
ALEJANDRA, MD
VANG, NA LY, DO
VASQUEZ AGUILAR, MARIO LUIS,
MD
VASQUEZ, LENA ALLYSON, MD
P5310
VASSER, ELIZABETH, MD
1/15/2013
P2804
VELA, JOSE VICTOR, MD
4/2/2012
P0806
P1502
N8591
P4915
P7366
VELASQUEZ, AUDEN C, MD
VERMA, NAMITA, DO
VICK, KATIE M, MD
VIDAL, AILEEN MICHELLE
DECIERDO, MD
VILLEGAS, MELISSA CATHLEEN,
DO
VITALE, KARLA SUE, DO
P5246
VO, KEVIN , MD
N7762
P4725
P5011
WAH, YU, MD
WAHEED, MUSADDIQ, MD
WALLACE, ROBIN, MD
N6762
WANDER, JASON FOX, DO
P1703
P7223
P0682
12/15/2011 12/15/2016 FAMILY MEDICINE
7/1/2013
8/2/2010
10/10/2008 10/10/2013 FAMILY MEDICINE
Secondary Specialty
(Self-Designated)
HOUSTON
6/4/2010
8/1/2013 None
3/19/2012 None
N/A
N/A
4/12/2013 None
N/A
7/22/2013 None
N/A
ODESSA
LICENSE
ISSUED
ACTIVE
6/4/2010 None
12/9/2009 None
N/A
N/A
ACTIVE
3/28/2011 None
N/A
TX
FAMILY PRACTICE
AUSTIN
TX
ACTIVE
ACTIVE
12/20/2011 None
7/22/2013 None
N/A
N/A
FAMILY MEDICINE
SPORTS MEDICINE
(FAMILY PRACTICE)
OCCUPATIONAL
MEDICINE
RIO GRANDE
CITY
TX
ACTIVE
ACTIVE
9/1/2010 None
10/20/2008 None
N/A
N/A
ROUND ROCK TX
ACTIVE
1/29/2013 None
N/A
SAN ANTONIO TX
4/16/2012 None
N/A
8/15/2011 None
11/18/2011 None
1/25/2011 None
N/A
N/A
N/A
8/9/2011 None
N/A
HOSPITALIST
9/15/2010
10/15/2012 10/15/2017 FAMILY MEDICINE
11/30/2012 11/30/2017 FAMILY MEDICINE
Disciplinary
Status Date
ACTIVE
HOSPITALIST
11/15/2012 11/15/2017 FAMILY MEDICINE
7/15/2013
1/4/2013
Registration
Status Date
Disciplinary
Status of
Texas
License
GLADEWATER TX
GERIATRICS
GENERAL PRACTICE
8/15/2011
11/15/2011 11/15/2016 FAMILY MEDICINE
1/18/2011
8/1/2011
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
HOUSTON
WACO
CORPUS
CHRISTI
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
TX
ACTIVE
SUGAR LAND
ANDREWS
TX
TX
ACTIVE
ACTIVE
WYLIE
FRENCH
CAMP
TX
ACTIVE
CA
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
HOSPITALIST
SPORTS MEDICINE
Page 90 of 301
11/29/2012 None
7/22/2013 None
SEE
PREVIOUS
1/9/2013 ORDER
N/A
N/A
10/18/2010 None
10/22/2012 None
12/19/2012 None
N/A
N/A
N/A
6/4/2010 None
N/A
8/30/2010
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P7723
P1834
P5906
WASHINGTON, GINA PATRICE, MD
WELDON, CHAD EDWARD, DO
WILLERS, GARY PAUL II, DO
8/15/2013
1/2/2012
3/15/2013
P0517
7/15/2011
N6771
N8158
P3269
P4532
P1838
N8473
WILLIAMS, JAMES STUART, MD
WILSON-OKAFOR, BRIDGET DEAN,
MD
WINEGEART, GARIN TODD, DO
WOODALL, BRUCE DALE, MD
YANES, JESUS AGUIRRE III, MD
YANG, BYUNGWOO, MD
YARAMADA, HEMALATHA, MD
P4838
YOUNG, ALISHA YI-WEN, MD
11/1/2012
P2405
N7513
YOUNGDAHL, MARCY EILEEN, MD
YSSA, MARIA D, MD
3/1/2012
8/16/2010
N6787
ZAHARIA, ADRIAN , MD
P3271
N4221
OBSTETRICS
EMERGENCY
MEDICINE
6/4/2010
11/15/2010 11/15/2015 FAMILY MEDICINE
5/15/2012
9/17/2012
1/2/2012
1/3/2011
6/4/2010
ZAHEDI, MOJDEH , MD
ZAHEER, AYESHA NAWAZ, MD
5/15/2012
8/21/2009
N6795
N4225
N7896
P4403
P0945
ZGOURIDES, GEORGE DEAN, MD
ZHANG, JINSONG , MD
ZON, JENNIFER T, MD
ADAMS, GRETCHEN MAY, MD
AFTAB, RAFIA, MD
6/4/2010
8/21/2009
10/1/2010
9/17/2012
9/15/2011
6/4/2015
8/21/2014
10/1/2015
9/17/2017
9/15/2016
N0594
AHMED, HALA MOHAMED ALY, MD
8/29/2008
8/29/2013 FAMILY PRACTICE
N7987
Secondary Specialty
(Self-Designated)
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY PRACTICE
FAMILY PRACTICE
N7199
AIRD, PAMELA ELIZABETH, MD
10/29/2010 10/29/2015 FAMILY PRACTICE
AKINMERESE, OLAWALE OPEYEMI,
MD
8/2/2010
N7049
P3501
N1248
AKKANTI, YAMINI APARNA, MD
ALIOTTA, MICHELLE LYNN, MD
ALLEN, BARBARA LYNNE, MD
PALLIATIVE
MEDICINE
TYLER
BAYTOWN
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
BIG LAKE
TX
FORT WORTH
ATHENS
SAN ANTONIO
WHEELING
TX
TX
TX
WV
DALLAS
PHARR
Practice City
FAMILY PRACTICE
7/15/2010
6/8/2012
10/10/2008 10/10/2013 FAMILY PRACTICE
Page 91 of 301
N/A
N/A
N/A
7/26/2011 None
N/A
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
TX
ACTIVE
12/12/2012 None
N/A
TX
ACTIVE
ACTIVE
4/12/2012 None
8/19/2010 None
N/A
N/A
6/4/2010 None
N/A
5/22/2012 None
10/2/2009 None
N/A
N/A
TX
TX
TX
TX
TX
FORT WORTH TX
HARLINGEN
TYLER
8/15/2013 None
1/31/2012 None
3/19/2013 None
6/4/2010
11/19/2010
6/4/2012
12/13/2012
1/16/2012
1/21/2011
HOSPITALIST
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
GERIATRIC
MEDICINE (INTERNAL
MED)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
SAINT LOUIS MO
SAN ANTONIO TX
BURLESON
RICHARDSON
DALLAS
PAMPA
GARLAND
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/4/2010
9/7/2009
10/4/2010
9/19/2012
11/11/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
11/11/2008 None
N/A
10/29/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/20/2010 None
N/A
7/15/2010 None
6/15/2012 None
10/15/2008 None
N/A
N/A
N/A
License
Number
Physician Name
P7380
P0535
ALLISON, JERRY ALVIN, MD
ALTAMIRANO, RAY , MD
P7738
ALVARADO, SERGIO ANTONIO, MD
N4911
ANGEL, RICHARD, DO
AREVALO SOSA, RICARDO
ANTONIO, MD
ARIENMUGHARE, MARYANNE
ONORIODE, MD
ASEH, OMERINE YEMBE, MD
ASHRAF, ASMA , MD
P6129
P5773
P0164
P6776
edicaid
edicaid
End Date
Designated)
8/1/2013
8/1/2011
8/30/2013
2/5/2010
4/12/2013
3/15/2013
7/1/2011
6/3/2013
P6577
ASIROT, RECHELLE LOZANO, MD
5/15/2013
P5774
AVERY, RICHEL ZAYAS, MD
3/15/2013
M2549
BALLESTAS, CARLOS ENRIQUE,
MD
N8612
BANDI, SRIJAYA, MD
N8486
BARKSDALE, ANTONIO DINO, MD
N6162
BATTLES, KRISTEN ANN, DO
N7395
BEVELS, GREGORY STEFAN, MD
N6188
BRAHMA, ANURADHA , MD
8/21/2009
2/4/2011
1/18/2011
6/4/2010
8/16/2010
6/4/2010
P1970
N8490
P7255
BROWN, BRIAN DOYLE, MD
BROWN, JARROD MICHAEL, MD
BUENDIA, JORGE , MD
2/1/2012
1/18/2011
7/15/2013
N4315
P0817
N0675
BUFFA, PETER MICHAEL SR, MD
BUNCH, DARRELL ALAN, DO
CANTU, ERNESTO JR, MD
11/6/2009
8/26/2011
8/29/2008
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICINE
SPORTS MEDICINE
(FAMILY PRACTICE)
Practice City
Registration
Status of
Practice
Texas
State
License
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
ACTIVE
ACTIVE
8/6/2013 None
8/5/2011 None
N/A
N/A
EL PASO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
9/9/2013 None
N/A
2/5/2010 None
N/A
4/12/2013 None
N/A
3/15/2013 None
7/27/2011 None
6/10/2013 None
N/A
N/A
N/A
6/14/2013 None
N/A
3/15/2013 None
N/A
9/9/2009 None
N/A
2/4/2011 None
N/A
1/18/2011 None
N/A
6/4/2010 None
N/A
8/16/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
2/3/2012 None
1/25/2011 None
7/22/2013 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
11/17/2009 None
9/1/2011 None
9/30/2008 None
N/A
N/A
N/A
TX
WACO
DALLAS
TX
TX
HOUSTON
TX
DALLAS
TX
DALLAS
ODESSA
TX
TX
MEXIA
TX
SAN ANTONIO TX
Page 92 of 301
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
Disciplinary
Status Date
DALLAS
TX
SAN ANTONIO TX
OBSTETRICS
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
N0685
Physician Name
CHAN VILLANUEVA, IMELDA
VALERA, MD
edicaid
edicaid
End Date
Designated)
8/29/2008
Secondary Specialty
(Self-Designated)
CHIKKALA, SUBHA , MD
CHINTA, SHASHI, MD
CHIRUMAMILLA, NEELIMA, MD
1/4/2013
6/3/2011
3/15/2013
P5789
CONNALLY, PATRICIA AILEEN, DO
3/15/2013
N3579
8/21/2009
5/15/2013
4/1/2013
7/1/2013
11/6/2009
N7916
CORRELL, BODIE JAMES, MD
CRITCHLOW, ALLISON LINDSEY,
DO
CRUMBAKER, MARIAH LINDSEY,
MD
DAR, KHOLA HAMEED, MD
DAVENPORT, DOMINIQUE
CONSTANZA, DO
DAVIS, LINDA MARLENE BOLLING,
MD
N9039
DEWITTE, DAVID M, MD
3/15/2011
P1986
P4750
DHILLON, RENNEE NAGRA, MD
DIAZ, KYLE IBANEZ, MD
2/1/2012
11/1/2012
FAMILY PRACTICE
P1539
P7269
N7081
N8909
DILMAGHANIAN, OMID GILLANI, MD
DREISS, WILLIAM , MD
DUTTA, PUJA MANOJIT, MD
EBRAHIM, ELLAHEH , MD
12/1/2011
7/15/2013
7/15/2010
3/1/2011
12/1/2016
7/15/2018
7/15/2015
3/1/2016
FAMILY MEDICINE
N5030
P6811
EGELSEE, LUIS JR, MD
ESCOVAR, RAPHAEL, MD
2/5/2010
6/3/2013
N6284
P1996
ESPINOZA, ERICA RUIZ, MD
FERRUFINO, LUIS EDGARDO, MD
6/4/2010
2/1/2012
N9371
GALLANT, JAMES FRANCIS, MD
GALLEGOS GARCIA, FERNANDO
SALVADOR, MD
4/8/2011
P5953
P7095
N4372
N2079
FAMILY MEDICINE
FP/OSTEO
MANIPULATION
MEDICINE
FAMILY MEDICINE
AEROSPACE
MEDICINE
10/15/2010 10/15/2015 FAMILY PRACTICE
2/6/2009
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
Practice City
MADISONVILL
E
TX
GENERAL
PREVENTIVE
MEDICINE
P5163
N9828
P5787
P6600
Registration
Status of
Practice
Texas
State
License
Page 93 of 301
Disciplinary
Status Date
ACTIVE
10/10/2008 None
N/A
TOLEDO
OH
ACTIVE
ACTIVE
ACTIVE
1/14/2013 None
6/21/2011 None
4/1/2013 None
N/A
N/A
N/A
GILLETTE
WY
ACTIVE
3/19/2013 None
N/A
TEMPLE
TX
ACTIVE
9/25/2009 None
N/A
COLUMBIA
MO
ACTIVE
7/4/2013 None
N/A
FORT WORTH TX
AUSTIN,
TX
ACTIVE
ACTIVE
4/8/2013 None
7/15/2013 None
N/A
N/A
KILLEEN
MISSION
VIEJO
TX
ACTIVE
1/25/2010 None
N/A
CA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
10/25/2010 None
N/A
3/15/2011 None
N/A
2/1/2012 None
11/6/2012 None
N/A
N/A
1/4/2012
7/19/2013
7/19/2010
3/25/2011
None
None
None
None
N/A
N/A
N/A
N/A
2/5/2010 None
6/5/2013 None
N/A
N/A
6/4/2010 None
2/6/2012 None
N/A
N/A
4/8/2011 None
N/A
2/24/2009 None
N/A
EL DORADO
AR
CHEYENNE
TYLER
HOUSTON
WY
TX
TX
ALPINE
TX
MCALLEN
TX
DECATUR
BRYAN,
TEXAS
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
OBSTETRICS
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N7797
N8295
GAMARNIK, SHARI CAROLYN, MD
GANTA, NEELIMA, MD
10/1/2010
12/15/2010 12/15/2015 FAMILY PRACTICE
P1180
GARCIA, JESSICA , DO
10/17/2011 10/17/2016 FAMILY PRACTICE
P2448
P1076
GIBBY, MARK HYRUM, MD
GOKAPAI, MADHUMATHI, MD
3/15/2012
10/3/2011
N4435
GORMAN, DEITRICK LE ELLEN, DO
11/6/2009
N5081
P6174
GRAIR, DIANA , MD
GUILLERMO, CARYL LIZETTE PIGA,
MD
GUTIERREZ-MACIAS, RODOLFO
GABRIEL, MD
N6339
P7117
HAMILTON, KALEB MICHAEL, MD
HARCOURT, KAREN AIKO, DO
6/4/2010
7/1/2013
N6887
HENBEST, HEATH SHYLER, DO
7/1/2010
N4443
2/5/2010
11/6/2009
4/12/2013
P4655
HERNANDEZ, MAURILIO, MD
10/15/2012 10/15/2017 FAMILY PRACTICE
P0407
HINOJOSA, ELIAS , MD
7/15/2011
P7650
N0846
N9072
IBARRA, RAFAEL ANDRES, MD
IGUH, BERNADETTE UCHE, MD
IMTIAZ, BATOOL, MD
8/15/2013
8/29/2008
3/15/2011
N7436
P2683
P0411
N1691
P0412
INGRAM, HOLLY RUDIN, DO
ISLAM, MAHMUDA, MD
JACKSON, SIMONA, MD
JACOB, CINDY SARA, MD
JAFFER, SALIMA , MD
P6192
P5825
JETPURI, ZAIBA IQBAL, DO
KALIDINDI, RAVI, MD
N8310
N4510
KARDATZKE, ELMER STANLEY, MD
KASULE, LOVE SOZI, MD
8/16/2010
4/2/2012
7/15/2011
12/12/2008 12/12/2013 FAMILY PRACTICE
7/15/2011
4/12/2013
3/15/2013
12/15/2010 12/15/2015 FAMILY PRACTICE
11/6/2009
Secondary Specialty
(Self-Designated)
HOSPITALIST
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
ACTIVE
10/4/2010 None
12/29/2010 None
N/A
N/A
CORPUS
CHRISTI
TX
ACTIVE
12/1/2011 None
N/A
GATESVILLE
TX
ACTIVE
ACTIVE
3/19/2012 None
10/9/2011 None
N/A
N/A
PECOS
TX
ACTIVE
LICENSE
ISSUED
11/24/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
11/16/2009 None
N/A
4/26/2013 None
N/A
6/4/2010 None
7/9/2013 None
N/A
N/A
7/1/2010 None
N/A
10/22/2012 None
N/A
7/20/2011 None
N/A
8/15/2013 None
10/7/2008 None
4/20/2011 None
N/A
N/A
N/A
WEBSTER
TOMBALL
HOSPITALIST
FAMILY PRACTICE
GERIATRICS
PAW PAW
CORPUS
CHRISTI
DALLAS
TX
TX
VICTORIA
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
TX
FAMILY MEDICINE
Page 94 of 301
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
MI
FAMILY MEDICINE
FAMILY PRACTICE
OBSTETRICS
Disciplinary
Status Date
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
ROSEBURG
OR
GREENCASTL
E
IN
ACTIVE
ACTIVE
8/16/2010
4/13/2012
8/22/2011
12/19/2008
9/6/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
4/12/2013 None
4/18/2013 None
N/A
N/A
12/30/2010 None
12/14/2009 None
N/A
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N5766
N7290
N4525
KELLY, CECILY HOSTRUP, MD
KHAN, RUBINA JAMAL, MD
KISSLING, CARL JAMES, MD
4/9/2010
8/2/2010
11/6/2009
P4773
P5663
11/1/2012
3/1/2013
P4668
KOHATSU, JORGE AUGUSTO, MD
KORTEWEG, JEREMY , MD
LASAKI, ABIOSE OLUFUNMILAYO,
MD
N7128
P2284
P1096
P7662
LAZZOPINA, PETER , MD
LE, MICHAEL, MD
LE, PHUC NHAT, MD
LEE, JANE EVELYN, DO
7/15/2010
3/1/2012
10/3/2011
8/15/2013
7/15/2015
3/1/2017
10/3/2016
8/15/2018
P1097
P0626
N3150
LEMO, PRETEI EBIKEME, MD
LIU, CHRISTINE Y, MD
LOMOTEY, CHAYLAH JOY, MD
10/3/2011
8/1/2011
5/29/2009
N1743
LOQUIAS, JESUS ARTHUR
PELONIA, MD
P7664
LOTT, FEYISETAN , DO
10/15/2012 10/15/2017 FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
12/12/2008 12/12/2013 FAMILY PRACTICE
8/15/2013
P0086
P4593
LY, KEITH K, DO
MAHAND, JENNIFFIER M, MD
6/15/2011
10/1/2012
J6560
MALONE, MARK STEVEN, MD
2/5/2010
N0943
MAMIGONIAN, JACQUES , MD
P5550
MANSOOR, TARIQ , MD
P2487
MANTHENA, SWAPNA, MD
N5844
MARTINEZ IRIZARRY, AXEL E, MD
8/29/2008
3/15/2012
Practice City
HOUSTON
DALLAS
PUBLIC HEALTH
FAMILY MEDICINE
FAMILY PRACTICE
FAMILY PRACTICE
HOSPITALIST
IOWA
WACO
SALT LAKE
CITY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Page 95 of 301
11/7/2012 None
3/4/2013 None
N/A
N/A
N/A
10/24/2012 None
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
10/13/2011 None
8/29/2011 None
6/29/2009 None
N/A
N/A
N/A
3/12/2009 None
N/A
GREENVILLE
AUSTIN
HARLINGEN
TX
TX
TX
RICHMOND
IN
DIMMITT
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
TX
GALVESTON
4/9/2010 None
8/12/2010 None
11/16/2009 None
UT
TX
MADISONVILL
E
TX
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Disciplinary
Status Date
ACTIVE
ACTIVE
BEAUMONT
BAYTOWN
Registration
Status Date
Disciplinary
Status of
Texas
License
LA
TX
2/8/2013
4/9/2010
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
TX
TX
7/15/2010
3/30/2012
10/6/2011
8/19/2013
8/15/2013 None
UNDER
BOARD
6/15/2011 ORDER
10/17/2012 None
N/A
2/5/2010 None
N/A
10/13/2008 None
N/A
ACTIVE
LICENSE
ISSUED
2/21/2013 None
N/A
3/15/2012 None
N/A
ACTIVE
4/16/2010 None
N/A
LICENSE
ISSUED
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
6/9/2011
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N6477
MARTINEZ, DORA ALICIA, MD
6/4/2010
P7502
MARTINEZ, OSCAR JR, MD
8/1/2013
N7459
P3199
MARTINEZ, RODOLFO RANDY, DO
MATHUR, MONIKA, MD
8/16/2010
5/15/2012
N5233
MCCRARY, JAMES EDWARD, DO
MEHTA, ARUN KUMAR
CHAMPAKLAL, MD
2/5/2010
11/6/2009
N4583
P6679
P6038
MELLOTT, JUSTIN, DO
MENDEZ, ANGELICA DURAN, MD
5/15/2013
4/1/2013
P1672
H3915
MIDGLEY, PHILIP GLENN, DO
MILLER, WILFRED DEAN, DO
P1477
MORALES MENDEZ, JACOBO S,
MD
N6936
MUNITZ, ELAINE MARIE, MD
7/1/2010
N5276
N7565
P1374
NANGRANI, CHAITALI D, MD
NARULA, JINNY, MD
NASIR, SOBIA , MD
2/5/2010
8/27/2010
11/4/2011
12/15/2011 12/15/2016 FAMILY PRACTICE
7/15/2011
Secondary Specialty
(Self-Designated)
Practice City
HOLDEN
FAMILY MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
MA
ACTIVE
LICENSE
ISSUED
P6482
ODOM, LYNDA GAYLE, MD
5/1/2013
N9926
N1032
P7014
N3217
OGBEBOR, CHRISTIAN EFOSA, MD
OKUMBOR, DAVID OSAGIE, MD
OLABODE, IRENE SEYI, DO
OLIVO, JENNY MARIA, MD
P5218
OWENS, JEANNIE, DO
1/4/2013
N7321
PALENCIA, DON DAVID, DO
8/2/2010
N6560
PARIKH, RAKESH, MD
6/4/2010
6/3/2011
8/29/2008
6/14/2013
5/29/2009
6/3/2016
8/29/2013
6/14/2018
5/29/2014
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
6/4/2010 None
N/A
8/1/2013 None
N/A
8/16/2010 None
6/4/2012 None
N/A
N/A
2/5/2010 None
N/A
MI
ACTIVE
12/23/2009 None
N/A
DIMMITT
TX
ACTIVE
ACTIVE
N/A
N/A
FORT WORTH TX
SAHUARITA
AZ
ACTIVE
ACTIVE
MCALLEN
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
5/21/2013 None
4/4/2013 None
UNDER
BOARD
12/19/2011 ORDER
7/21/2011 None
SEE
PREVIOUS
11/15/2011 ORDER
TX
DENVER CITY TX
ACTIVE
FAMILY MEDICINE
CONROE
GREENVILLE
TX
TX
FAMILY MEDICINE
EMERGENCY
MEDICINE
REPRODUCTIVE
ENDOCRINOLOGY
AND INFERTILITY
SHIPROCK
SULPHUR
SPRINGS
NM
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TX
ARLINGTON
TX
Page 96 of 301
Disciplinary
Status Date
SOUTHGATE
11/15/2011 11/15/2016 FAMILY PRACTICE
Registration
Status Date
Disciplinary
Status of
Texas
License
12/1/2011
N/A
7/5/2011
7/1/2010 None
N/A
2/5/2010 None
9/10/2010 None
11/8/2011 None
N/A
N/A
N/A
5/7/2013 None
N/A
6/15/2011
9/8/2008
6/18/2013
7/10/2009
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
1/8/2013 None
N/A
ACTIVE
LICENSE
ISSUED
9/9/2010 None
N/A
6/4/2010 None
N/A
License
Number
edicaid
edicaid
End Date
Designated)
7/15/2011
Secondary Specialty
(Self-Designated)
PENNINGTON, BRENT LEE, MD
8/1/2013
PHAM, NIKKI HOA THI, MD
4/2/2012
Physician Name
P0464
PARVATANENI, SIRISHA, MD
P7534
P2756
N2732
N8706
PHUNG, VU , MD
PIMSLEUR, MARC , MD
N3995
P7691
PINCKNEY, JAMES SAMUEL II, MD
PINNAMANENI, PAVAN , MD
P1809
PROVENCIO, MAURO JR, MD
N4023
RAMIREZ, STEVE , MD
N2750
4/3/2009
2/4/2011
8/21/2009
8/15/2013
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
SPORTS MEDICINE
(FAMILY PRACTICE)
Practice City
ACTIVE
REFUGIO
HOUSTON
HARLINGEN
HUNTINGTON TX
N/A
N/A
EL PASO
TX
ACTIVE
1/4/2012 None
N/A
TX
ACTIVE
9/10/2009 None
N/A
TX
ACTIVE
4/15/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
4/16/2012 None
N/A
1/3/2011 None
N/A
4/3/2009
P2766
4/2/2012
GARLAND
N8449
RAZA, ZAMAR FATIMA, MD
1/3/2011
REYNOLDS, MICHAEL BRYAN, DO
3/1/2011
N/A
9/29/2009 None
8/20/2013 None
RANA, IRFAN RAFIQ, MD
RATNAYAKE, MAHESHIKA
KALPANA, MD
N8977
4/2/2012 None
7/1/2013
ACTIVE
ACTIVE
BRYAN
GRAND
SALINE
N/A
N/A
N/A
2/1/2013
8/1/2011 None
UNDER
BOARD
8/7/2013 ORDER
5/18/2009 None
2/14/2011 None
8/21/2009
REYES, DAVID , MD
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
ACTIVE
ACTIVE
P5453
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
1/2/2012
AEROSPACE
MEDICINE
Registration
Status of
Practice
Texas
State
License
GALVESTON
COLORADO
CITY
TX
ACTIVE
2/6/2013 None
N/A
TX
ACTIVE
3/15/2011 None
N/A
RICHARDSON, MICHAEL L JR, MD
RIGNEY, CHARLES EDWARD III,
MD
RIOJAS, MARCELA , MD
6/15/2011
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
FORT WORTH TX
ACTIVE
6/20/2011 None
N/A
11/1/2012
12/1/2010
GENERAL PRACTICE DEL RIO
TX
FAMILY MEDICINE
SAN ANTONIO TX
ACTIVE
ACTIVE
11/9/2012 None
1/10/2011 None
N/A
N/A
6/3/2013
FAMILY MEDICINE
ACTIVE
7/1/2013 None
N/A
N7865
RIVERA VAZQUEZ, MARIMER , MD
ROA, MARIO RIZALINO BASCON
JR, MD
10/1/2010
10/12/2010 None
N/A
N5364
ROBERT, MARSHALL BROOKS, MD
2/5/2010
2/5/2010 None
N/A
P0121
H1526
N8238
P6903
MUENSTER
Page 97 of 301
TX
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P4505
P1136
ROHM, TREVOR , MD
ROOT, JOHN CHINNICK, MD
N2275
N1436
N5378
P4808
SAENZ, LINDA JO, MD
SAFFARI, BEHROOZ , MD
SALAZAR-ALAMILLO, UBALDO
JULIAN , MD
SALEEM, KASHIF , MD
N5994
SANCHEZ, ADOLFO V, MD
edicaid
edicaid
End Date
Designated)
9/17/2012
10/3/2011
Secondary Specialty
(Self-Designated)
2/6/2009
10/10/2008 10/10/2013 FAMILY PRACTICE
2/5/2010
11/1/2012
4/9/2010
N7341
SANUSI, LUKMAN ADESOLA, MD
8/2/2010
N1880
N9294
P2522
N1893
N9957
SATTAR, BIBI TASLEYMA, DO
SCANLAN, LYNNE, DO
SHARMA, SUJATA, MD
SHELTON, KEVIN JAMES, MD
SHIBLI, UROOJ BASIT, MD
P2924
P2529
4/13/2012
3/15/2012
N7493
N7587
P6282
SHITTA-BEY, ABIOLA LATIFAT, MD
SIMON, CYRIL MAKIL, DO
SOSA RODRIGUEZ, JAVIER
EDUARDO, MD
ST VICTOR, RUTH, DO
STONE, JAMILLA CHRISTINE, MD
8/16/2010
8/27/2010
4/12/2013
P3081
P7714
STRICKLAND, KIMBERLY LYNN, DO
TARIQ, ZARLISH, MD
5/1/2012
8/15/2013
N7181
N4793
P7716
P6736
N9318
N4802
N7661
N7503
TAVAREZ, ROMAN ERIK, MD
TENGCO, ROMULO CALATA, MD
THARIAN, DIMPLE THARA, MD
THOMAS, NAJA MARI, MD
THOMPSON, STERLING W, MD
TIGLEY, THOM JUEL ESPINA, MD
TOWNSEND, MONICA ELLEN, MD
TRAN, CHAU MY, MD
7/15/2010
11/6/2009
8/15/2013
5/15/2013
4/1/2011
11/6/2009
9/1/2010
8/16/2010
7/15/2015
11/6/2014
8/15/2018
5/15/2018
4/1/2016
11/6/2014
9/1/2015
8/16/2015
N1928
P6741
TRAZZERA, MELISSA LILLYAN, DO
URIBE, EDUARDO , MD
12/12/2008 12/12/2013 FAMILY PRACTICE
4/1/2011
3/15/2012
12/12/2008 12/12/2013 FAMILY PRACTICE
6/3/2011
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
OBSTETRICS AND
GYNECOLOGY
FAMILY
PRACTICE/OMM
Practice City
Registration
Status of
Practice
Texas
State
License
QUANAH
ALTUS
CORPUS
CHRISTI
TX
OK
ACTIVE
ACTIVE
TX
STORM LAKE
LUBBOCK
IA
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
MIRAMAR
LEANDER
FL
TX
CELINA
MESQUITE
TX
TX
ODESSA
TX
OBSTETRICS
LULING
TX
WAVERLY
IA
HOSPITALIST
HOSPITALIST
12/12/2008 12/12/2013 FAMILY PRACTICE
5/15/2013
Page 98 of 301
HAMILTON
AMARILLO
NJ
TX
GONZALES
TAMPA
TEXARKANA
TX
FL
TX
HARLINGEN
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/24/2012 None
10/25/2011 None
N/A
N/A
3/9/2009 None
11/7/2008 None
N/A
N/A
2/5/2010 None
11/21/2012 None
N/A
N/A
4/9/2010 None
N/A
8/2/2010 None
N/A
12/18/2008
4/26/2011
3/23/2012
12/23/2008
6/20/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
4/13/2012 None
3/22/2012 None
N/A
N/A
8/16/2010 None
9/6/2010 None
4/22/2013 None
N/A
N/A
N/A
5/10/2012 None
8/26/2013 None
N/A
N/A
7/15/2010
12/23/2009
8/22/2013
5/21/2013
4/6/2011
2/2/2010
9/6/2010
8/31/2010
None
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
2/9/2009 None
5/21/2013 None
N/A
N/A
License
Number
Physician Name
P3473
VADDEMPUDI, VIDYA, MD
N8360
VEASEY, GILBERT DEAN SR, MD
N1488
VELAZQUEZ, JUAN PENA, MD
Medicare/M
edicaid
Agreement
Start Date
6/1/2012
12/15/2010
10/10/2008
Medicare/M
edicaid
Agreement
End Date
6/1/2017
12/15/2015
10/10/2013
Primary Specialty (SelfDesignated)
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
N9418
VILLAFRIA, RAMON GARCIA, MD
4/8/2011
N9976
P2393
WAGLE, KAMAL CHANDRA, MD
WALGAMA, ALISON LANE, MD
6/3/2011
3/1/2012
P1244
WALZ, DANIELLE, MD
10/17/2011 10/17/2016 FAMILY PRACTICE
N5485
P5762
N7981
WIN, OHMAR, MD
WU, MONICA ADWOAFUAA, MD
YIN, ZHENGNAN , MD
ZAIDI, SYED MUHAMMAD HAMMAD
ALI, MD
2/5/2010
3/1/2013
10/15/2010 10/15/2015 FAMILY PRACTICE
P1441
N4224
ZAROSKY, JOHN MATTHEW, MD
N6173
BERG, MARY JEAN, MD
P3156
GILLETTE, STEPHANIE, MD
P4575
P6438
HEKEREM, KEMKA ONUZEM, MD
JAGRAM-PAYER, NALINI RAVIDAI,
MD
JOHNSON, CHARLES FRANKLIN,
MD
KONZELMANN, HENRY JOSEPH,
MD
G0023
ROGERS, WILLIAM BRETT, MD
P1591
SCHWECHTEN, KEVIN J, MD
P0185
CLEARFIELD, DANIEL ADAM, DO
IRVINE-MOORE, LAPONNA RAE,
DO
P0413
N6391
N4494
11/4/2011
8/21/2009
6/4/2010
5/15/2012
Secondary Specialty
(Self-Designated)
URGENT CARE
MEDICINE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
FAMILY PRACTICE 6/4/2015 EMERGENCY MED
FAMILY PRACTICE 5/15/2017 EMERGENCY MED
10/1/2012
10/1/2017
7/15/2011
7/15/2016
6/4/2010
6/4/2015
5/1/2013
5/1/2018
7/1/2013
7/1/2018
12/1/2011
12/1/2016
7/1/2011
7/1/2016
11/6/2009
11/6/2014
FAMILY
PRACTICE/OMM
FAMILY
PRACTICE/OMM
SPORTS MEDICINE
(FAMILY PRACTICE)
OCCUPATIONAL
ENVIRONMENTAL
MEDICINE
Registration
Status of
Practice
Texas
Practice City
State
License
ACTIVE
DICKINSON
TX
ACTIVE
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
WACO
TX
ACTIVE
4/8/2011 None
N/A
6/3/2011 None
3/16/2012 None
N/A
N/A
10/25/2011 None
N/A
2/5/2010 None
3/22/2013 None
11/1/2010 None
N/A
N/A
N/A
11/30/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/31/2009 None
N/A
6/4/2010 None
N/A
SAN ANTONIO TX
ACTIVE
HOUSTON
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
MUSKOGEE
OK
ACTIVE
FORT WORTH TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
6/8/2012 None
N/A
12/24/2010 None
N/A
11/3/2008 None
N/A
MANGUM
OK
ACTIVE
5/24/2012 None
N/A
HOUSTON
TX
ACTIVE
10/4/2012 None
N/A
SPIRIT LAKE
IA
ACTIVE
LICENSE
ISSUED
8/18/2011 None
N/A
6/4/2010 None
N/A
PILOT KNOB
MO
ACTIVE
5/7/2013 None
N/A
FAMILY MEDICINE
DOWAGIAC
MI
ACTIVE
7/12/2013 None
N/A
FAMILY MEDICINE
SPORTS MEDICINE
(FAMILY PRACTICE)
CORINTH
MS
ACTIVE
1/4/2012 None
N/A
FORT WORTH TX
ACTIVE
7/8/2011 None
N/A
ACTIVE
1/7/2010 None
N/A
Page 99 of 301
License
Number
Physician Name
P6201
KIRKPATRICK, IAN SHANE, DO
P7794
N8215
LAKKO, ROBERT JORDAN, DO
LOWE ECHEVARRIA, LINDA
ANGELA, DO
N5244
MEREDITH, SARAH JOANNE, DO
N5259
MOORE, ALTON E. II, DO
P1794
NGUYEN, JENNIFER LIEN, DO
P5112
NOORDA, SCOTT J, DO
P5112
NOORDA, SCOTT J, DO
P5112
NOORDA, SCOTT J, DO
P0656
QUALLS, JAMES ROBERT, DO
P7707
SHAMA, LEAH KATHERINE, DO
edicaid
edicaid
End Date
Designated)
FAMILY
4/12/2013
4/12/2018 PRACTICE/OMM
FAMILY
8/30/2013
FAMILY
12/1/2010
FAMILY
2/5/2010
FAMILY
2/5/2010
FAMILY
1/2/2012
FAMILY
12/17/2012 12/17/2017 PRACTICE/OMM
FAMILY
12/17/2012 12/17/2017 PRACTICE/OMM
FAMILY
12/17/2012 12/17/2017 PRACTICE/OMM
FAMILY
8/1/2011
FAMILY
8/15/2013
FAMILY
7/1/2013
FAMILY
PRACTICE/PSYCHIATR
4/9/2010
4/9/2015 Y
FAMILY
PRACTICE/PSYCHIATR
1/4/2013
1/4/2018 Y
P7230
ZACHARIAH, AVEEN BABU, DO
N5535
ANTOINE, CHRISTINA, MD
P5216
OLIPHANT, NEKESHA, MD
P6871
MOISI, MARC DANIEL, MD
6/3/2013
P2004
GREAR, BENJAMIN JOPLIN, MD
2/1/2012
P6322
AMARO, JUSTIN AARON, DO
ADIMOOLAM,
VENKATAVIJAYBABU, MD
5/1/2013
N7385
8/16/2010
Secondary Specialty
(Self-Designated)
Practice City
GERIATRICS
OBSTETRICS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
4/12/2013 None
N/A
TX
ACTIVE
9/4/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/4/2011 None
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
2/8/2012 None
N/A
CONROE
TX
ACTIVE
1/7/2013 None
N/A
CONROE
TX
ACTIVE
1/7/2013 None
N/A
CONROE
TX
ACTIVE
1/7/2013 None
N/A
WACO
TX
ACTIVE
8/26/2011 None
N/A
SAN ANTONIO TX
ACTIVE
8/28/2013 None
N/A
ACTIVE
7/9/2013 None
N/A
LICENSE
ISSUED
4/9/2010 None
N/A
N/A
ACTIVE
2/4/2013 None
SEE
PREVIOUS
6/6/2013 ORDER
ACTIVE
2/7/2012 None
N/A
LICENSE
ISSUED
5/1/2013 None
N/A
8/23/2010 None
N/A
FAMILY
PRACTICE/OMM
Page 100 of 301
Disciplinary
Status Date
HEREFORD
HOSPITALIST
6/3/2018 FLEXIBLE
FOOT AND ANKLE,
ORTHOPEDIC
2/1/2017 ORTHOPEDICS
SURGERY
FP/OSTEO
MANIPULATION
5/1/2018 MEDICINE
GASTROENTEROLOG
8/16/2015 Y
Registration
Status Date
Disciplinary
Status of
Texas
License
ABILENE
TX
ACTIVE
DALLAS
ODESSA
TX
TX
ACTIVE
5/15/2013
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
GASTROENTEROLOG
P7375
AKOTIA, VIMESH BALUBHAI, MD
8/1/2013
8/1/2018 Y
GASTROENTEROLOG
P6568
ALI, SHAHID, MD
5/15/2013
5/15/2018 Y
GASTROENTEROLOG
N6806
ALQAHTANI, SALEH ALI, MD
7/1/2010
7/1/2015 Y
GASTROENTEROLOG
N7674
BACHIR, NATALIE MYRNA, MD
9/15/2010
9/15/2015 Y
GASTROENTEROLOG
P6948
BARNES, MAISHA NICHOLE, MD
6/14/2013
6/14/2018 Y
GASTROENTEROLOG
P4420
BELO, ANGELICA CHIOMA, MD
9/17/2012
9/17/2017 Y
BLECHACZ, BORIS ROMAN
GASTROENTEROLOG
P0815
ALEXANDER, MD
8/26/2011
8/26/2016 Y
GASTROENTEROLOG
N3504
BLONSKY, JEFFERY J, MD
8/21/2009
8/21/2014 Y
GASTROENTEROLOG
N7398
BOEHMKE, JAMES JOSEPH JR, DO
8/16/2010
8/16/2015 Y
GASTROENTEROLOG
P1060
CHALASANI, RAMBABU , MD
10/3/2011
10/3/2016 Y
GASTROENTEROLOG
P3133
CHAUDHRY, SUFIYAN HAFEEZ, MD
5/15/2012
5/15/2017 Y
GASTROENTEROLOG
N8497
CHAVA, SAMYUKTA, MD
1/18/2011
1/18/2016 Y
GASTROENTEROLOG
N8499
CHEPYALA, PAVAN, MD
1/18/2011
1/18/2016 Y
GASTROENTEROLOG
P7622
CHISHOLM, SIAN S, MD
8/15/2013
8/15/2018 Y
GASTROENTEROLOG
P0713
CHOUEIRI, NABIL ELIA, MD
8/15/2011
8/15/2016 Y
CLARKE, JERMAINE GARNETTE,
GASTROENTEROLOG
P2971
DO
5/1/2012
5/1/2017 Y
GASTROENTEROLOG
P3616
CLULEY, JOHN DAVID, MD
6/15/2012
6/15/2017 Y
GASTROENTEROLOG
P0363
COHEN, DAN CHAIM, MD
7/15/2011
7/15/2016 Y
GASTROENTEROLOG
N5649
DESAI, KUMAR SUBODH, MD
4/9/2010
4/9/2015 Y
GASTROENTEROLOG
N4397
ELRAIE, KHALED FOUAD, MD
11/6/2009
11/6/2014 Y
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE PALESTINE
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
ACTIVE
8/26/2013 None
N/A
ACTIVE
5/29/2013 None
N/A
7/15/2010 None
N/A
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
9/15/2010 None
N/A
INTERNAL MEDICINE MINNEAPOLIS MN
ACTIVE
6/20/2013 None
N/A
INTERNAL MEDICINE MARSHALL
ACTIVE
LICENSE
ISSUED
9/19/2012 None
N/A
8/26/2011 None
N/A
ACTIVE
LICENSE
ISSUED
9/2/2009 None
N/A
8/16/2010 None
N/A
10/17/2011 None
N/A
HEPATOLOGY
DALLAS
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
HEPATOLOGY
LACKLAND
TX
INTERNAL MEDICINE
HOUSTON
TX
ACTIVE
TN
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/31/2012 None
N/A
1/18/2011 None
N/A
1/18/2011 None
N/A
TX
ACTIVE
8/19/2013 None
N/A
TX
ACTIVE
8/22/2011 None
N/A
INTERNAL MEDICINE SHERMAN
EMERGENCY
MEDICINE
TX
ACTIVE
LICENSE
ISSUED
5/3/2012 None
N/A
6/15/2012 None
N/A
GASTROENTEROLOG
Y
TX
8/1/2011 None
N/A
4/29/2010 None
N/A
11/6/2009 None
N/A
INTERNAL MEDICINE MEMPHIS
INTERNAL MEDICINE
INTERNAL MEDICINE
HARKER
HEIGHTS
Page 101 of 301
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
P2239
Physician Name
P5179
FRACHTMAN, STEVEN JAY, MD
GAFFNEY, KRISTIN ALEXANDRIA,
DO
N2526
GHAZALE, AMAAR HASSAN, MD
P2246
GOGIA, SUDHANSHU, MD
P1314
GORREPATI, NAVAKANTH, MD
P6629
HAQ, OMAR ANWAR, MD
HOQUE, MOHAMMED NASEEMUL,
MD
N8405
N0857
N6385
JAFRI, NADIM SYED, MD
JARBRINK-SEHGAL, MARIA
ELLIONORE, MD
edicaid
edicaid
End Date
Designated)
GASTROENTEROLOG
3/1/2012
3/1/2017 Y
GASTROENTEROLOG
1/4/2013
1/4/2018 Y
GASTROENTEROLOG
4/3/2009
4/3/2014 Y
GASTROENTEROLOG
3/1/2012
3/1/2017 Y
GASTROENTEROLOG
11/4/2011
11/4/2016 Y
GASTROENTEROLOG
5/15/2013
5/15/2018 Y
GASTROENTEROLOG
1/3/2011
1/3/2016 Y
GASTROENTEROLOG
8/29/2008
8/29/2013 Y
GASTROENTEROLOG
6/4/2010
6/4/2015 Y
P2129
JONES, CARL RAY, DO
2/10/2012
2/10/2017
P7654
JULURI, RAVI, MD
8/15/2013
8/15/2018
N5752
JUSTINO, EDMUNDO SAMUEL, MD
4/9/2010
4/9/2015
N3111
KANG, HYON SIK, DO
5/29/2009
5/29/2014
P2133
KAPOOR, ASHWANI, MD
2/10/2012
2/10/2017
P2016
KASTURI, KRISHNA SAGAR, MD
2/1/2012
2/1/2017
P6843
KAUR, MANREET, MD
6/3/2013
6/3/2018
N5774
KHATIB, KHALDUN , MD
4/9/2010
4/9/2015
P0746
KOYA, LAXMI DEEPIKA, MD
8/15/2011
8/15/2016
N7297
KRIEGER, JEFFREY LOUIS, MD
8/2/2010
8/2/2015
N8943
KUNDROTAS, LEON, MD
3/1/2011
3/1/2016
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
INTERNAL MEDICINE
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
3/15/2012 None
N/A
ACTIVE
1/18/2013 None
N/A
4/8/2009 None
N/A
3/1/2012 None
N/A
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE
ACTIVE
11/28/2011 None
N/A
INTERNAL MEDICINE ATLANTA
GA
THE
INTERNAL MEDICINE WOODLANDS TX
ACTIVE
6/5/2013 None
N/A
ACTIVE
1/31/2011 None
N/A
ACTIVE
LICENSE
ISSUED
9/18/2008 None
N/A
6/4/2010 None
SEE
PREVIOUS
2/16/2012 ORDER
N/A
ACTIVE
LICENSE
ISSUED
8/19/2013 None
N/A
4/9/2010 None
N/A
KEESLER AFB MS
ACTIVE
7/27/2009 None
N/A
RICHMOND
ACTIVE
LICENSE
ISSUED
2/27/2012 None
N/A
2/1/2012 None
N/A
TX
INTERNAL MEDICINE
GASTROENTEROLOG
Y
GASTROENTEROLOG
Y
INTERNAL MEDICINE
GASTROENTEROLOG
Y
INTERNAL MEDICINE
GASTROENTEROLOG
Y
INTERNAL MEDICINE
GASTROENTEROLOG
Y
GASTROENTEROLOG
Y
INTERNAL MEDICINE
GASTROENTEROLOG GASTROENTEROLOG
Y
Y
GASTROENTEROLOG
Y
HEPATOLOGY
GASTROENTEROLOG
Y
INTERNAL MEDICINE
GASTROENTEROLOG
Y
INTERNAL MEDICINE
GASTROENTEROLOG
Y
INTERNAL MEDICINE
Page 102 of 301
NACOGDOCH
ES
TX
VA
ACTIVE
2/13/2012
HOUSTON
TX
ACTIVE
6/28/2013 None
N/A
MESQUITE
TX
ACTIVE
4/19/2010 None
N/A
TAMPA
FL
ACTIVE
8/29/2011 None
N/A
TYLER
LACKLAND,
AFB
TX
ACTIVE
8/5/2010 None
N/A
TX
ACTIVE
3/14/2011 None
N/A
License
Number
Physician Name
N7299
KURUPATH, VINOD, MD
N8948
LOPEZ-ROMAN, ORLANDO A, MD
K5511
N2653
LUNSFORD, TISHA N, MD
MAYORGA, CHRISTIAN ANTONIO
JR, MD
MCNEILL, CHRISTOPHER JOHN,
MD
N9103
NAYYAR, SANJAY, MD
P2043
NGUYEN, NHAT QUANG, MD
N8055
PADDA, MANMEET SINGH, MD
N5931
PANDE, HEMANT, MD
PARUPUDI, SREERAM VENKATA
JAGANNADHA, MD
P5419
N8135
P1009
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
Practice City
GASTROENTEROLOG
8/2/2010
8/2/2015 Y
GASTROENTEROLOG
3/1/2011
3/1/2016 Y
2/5/2010
2/1/2013
4/3/2009
3/15/2011
2/1/2012
10/29/2010
4/9/2010
11/15/2010
N2748
PATEL, KALPESH KANU, MD
PUDHOTA, SUNITHA GUDAPATI,
MD
QUAINE, PATRICIA ANN REYES,
MD
RAMAKRISHNAN,
THIRUVENGADAM , MD
N9778
SEJPAL, DIVYESH VASANT, MD
P6523
N8062
SIDDIQUI, UMAIR MAHMOOD, MD
SIVAPRAKASAPILLAI, NIRMALA
MAYA, MD
P0677
SUN, JACHI GEORGE, MD
8/1/2011
N8466
TANIMU, SABO BUKAR, MD
1/3/2011
M3769
TREVINO, JESSICA MARIE, MD
2/8/2013
P1484
P7020
9/15/2011
11/15/2011
6/14/2013
4/3/2009
5/16/2011
5/1/2013
10/29/2010
GASTROENTEROLOG
2/5/2015 Y
INTERNAL MEDICINE
GASTROENTEROLOG
2/1/2018 Y
INTERNAL MEDICINE
GASTROENTEROLOG
4/3/2014 Y
INTERNAL MEDICINE
GASTROENTEROLOG
3/15/2016 Y
GASTROENTEROLOG
2/1/2017 Y
INTERNAL MEDICINE
GASTROENTEROLOG
10/29/2015 Y
INTERNAL MEDICINE
GASTROENTEROLOG
4/9/2015 Y
INTERNAL MEDICINE
GASTROENTEROLOG
11/15/2015 Y
INTERNAL MEDICINE
GASTROENTEROLOG
9/15/2016 Y
INTERNAL MEDICINE
GASTROENTEROLOG
11/15/2016 Y
GASTROENTEROLOG
6/14/2018 Y
INTERNAL MEDICINE
GASTROENTEROLOG GASTROENTEROLOG
4/3/2014 Y
Y
GASTROENTEROLOG
5/16/2016 Y
GASTROENTEROLOG
5/1/2018 Y
INTERNAL MEDICINE
GASTROENTEROLOG
10/29/2015 Y
GASTROENTEROLOG
8/1/2016 Y
INTERNAL MEDICINE
GASTROENTEROLOG
1/3/2016 Y
GASTROENTEROLOG
2/8/2018 Y
INTERNAL MEDICINE
Page 103 of 301
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
8/20/2010 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
3/22/2011 None
N/A
2/5/2010 None
N/A
DALLAS
TX
ACTIVE
2/4/2013 None
N/A
TEMPLE
TX
ACTIVE
4/20/2009 None
N/A
N LAS VEGAS
NV
3/18/2011 None
N/A
2/1/2012 None
N/A
10/29/2010 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LEESVILLE
LA
ACTIVE
4/29/2010 None
N/A
GALVESTON
TX
ACTIVE
12/13/2010 None
N/A
HOUSTON
TX
ACTIVE
9/22/2011 None
N/A
MANSFIELD
TX
ACTIVE
11/24/2011 None
N/A
TOMBALL
TX
ACTIVE
6/20/2013 None
N/A
GALVESTON
TX
ACTIVE
4/13/2009 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/19/2011 None
N/A
5/1/2013 None
N/A
10/29/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/22/2011 None
N/A
1/3/2011 None
N/A
ACTIVE
2/14/2013 None
N/A
SAN ANTONIO TX
AUSTIN
TX
License
Number
Physician Name
P2800
TRIVEDI, APURVA NAVIN, MD
J1149
P6743
TROTTER, JAMES FORD, MD
VANDERVELDT, HENDRIKUS
STEPHEN, MD
P2558
WANG, WEIZHENG WILLIAM, MD
N9988
YEGANEH, MELINA , MD
P0691
ACKLIN, JOY DEANN, DO
AKINKUOTU, ADESOLA CYNTHIA
OMOWONUOLA, MD
P7603
edicaid
edicaid
End Date
Designated)
GASTROENTEROLOG
4/2/2012
4/2/2017 Y
GASTROENTEROLOG
4/3/2009
4/3/2014 Y
GASTROENTEROLOG
5/15/2013
5/15/2018 Y
GASTROENTEROLOG
3/15/2012
3/15/2017 Y
GASTROENTEROLOG
6/3/2011
6/3/2016 Y
8/15/2011
8/15/2016 GENERAL PRACTICE
8/15/2013
10/3/2011
7/1/2013
6/3/2013
8/30/2013
1/2/2012
10/1/2012
Secondary Specialty
(Self-Designated)
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
INTERNAL MEDICINE BETHESDA
MD
ACTIVE
4/6/2012 None
N/A
HEPATOLOGY
TX
ACTIVE
4/9/2009 None
N/A
ACTIVE
LICENSE
ISSUED
7/8/2013 None
N/A
3/15/2012 None
N/A
ACTIVE
6/17/2011 None
N/A
ACTIVE
8/29/2011 None
N/A
DALLAS
HEPATOLOGY
HOUSTON
TX
GENERAL SURGERY
ACTIVE
P7071
P6787
ALVAREZ-CARDONA, JULIO JOSE,
MD
BERMUDEZ, CHRISTOPHER
JOSEPH, MD
BRANT, SARAH MARGARET, MD
P7746
BROOKS, JOHN A, MD
P1740
CLARK, JAMES ALLEN, MD
P4558
COLEMAN, ALAN MICHAEL, MD
N6254
6/4/2010
P0194
P5362
N0780
DENDULURI, SANDEEP, MD
DENNISON, MATTHEW STEPHEN,
MD
FOSTER, TROY , DO
GEIGEL, CARLOS OSCAR, MD
7/1/2011
2/1/2013
8/29/2008
D8040
P0107
P1576
MOTES, JOSEPH L JR, MD
NGUYEN, ETHAN QUAN, MD
PACHA, OMAR , MD
10/3/2011
6/15/2011
12/1/2011
P0469
PIERRE, JAMES ANTHONY JR, MD
7/15/2011
Page 104 of 301
P1041
Practice City
Registration
Status of
Practice
Texas
State
License
INTERNAL MEDICINE
DALLAS
TX
HEREFORD
TX
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
ACTIVE
WOODVILLE
TX
GENERAL SURGERY
DERMATOLOGY
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
8/23/2013 None
UNDER
BOARD
10/21/2011 ORDER
N/A
9/13/2011
7/1/2013 None
6/18/2013 None
N/A
N/A
8/30/2013 None
UNDER
BOARD
1/2/2012 ORDER
N/A
12/15/2011
12/30/2012 None
N/A
6/4/2010 None
N/A
7/1/2011 None
2/6/2013 None
10/8/2008 None
UNDER
BOARD
10/9/2011 ORDER
6/17/2011 None
12/14/2011 None
N/A
N/A
N/A
7/21/2011 None
9/14/2011
N/A
N/A
N/A
License
Number
P6512
Physician Name
RIVERA-SOTO, ANGEL MANUEL,
MD
RODRIGUEZ, LIMAEL ESTEBAN,
MD
P0288
SAGER, DERICK ALAN, MD
N1888
SHAH, DARSHAN PRAVIN, MD
N9984
WILLIAMS, TERESA RENEE, MD
P7698
edicaid
edicaid
End Date
Designated)
8/15/2013
5/1/2013
7/1/2011
12/12/2008 12/12/2013 GENERAL PRACTICE
PH00002 ABRAMSKY, MITCHEL JAY, MD
5/29/2009
N6031
P6565
N9428
4/9/2010
5/15/2013
4/15/2011
GENERAL
PREVENTIVE
5/29/2014 MEDICINE
GENERAL
PREVENTIVE
4/9/2015 MEDICINE
5/15/2018 GENERAL SURGERY
8/30/2013
6/8/2012
3/1/2011
6/4/2010
8/21/2009
P7736
SMITH, KIRK LANE, MD
AKSADE, ARTUN, MD
ALBRECHT, WILLIAM CLAY, MD
ALIBHAI, MUSTAFA
HUSSAMUDDIN, MD
P3500
N8880
ALI-OSMAN, FRANCIS REGINALD,
MD
ALLEN, LISA RACHEL, MD
N6140
N3438
ALLISON, NATHAN D, MD
ALVAREZ, ALLEN ALBERT, MD
6/3/2011
N7389
N3447
AMIRAFSHARI, AKBAR, MD
ANDERSON, C ERIK, MD
8/16/2010
8/21/2009
N4250
ANGIER, GREGGORY NABIL, MD
11/6/2009
P2580
ASKENASY, ERIK PAUL, MD
AYOOLA, FOLAHAN KOLAWOLE,
MD
4/2/2012
4/13/2012
P2826
P7385
N7677
BARBA, CARLOS ALBERTO, MD
BASSIN, ALAN SCOTT, MD
8/1/2013
9/15/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
INTERNAL MEDICINE
ACTIVE
GENERAL PRACTICE DALLAS
TX
N/A
ACTIVE
LICENSE
ISSUED
5/7/2013 None
N/A
7/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
2/2/2009 None
N/A
6/3/2011 None
N/A
ACTIVE
8/12/2009 None
N/A
GALVESTON
ODESSA
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
4/14/2010 None
5/17/2013 None
4/22/2011 None
N/A
N/A
N/A
8/30/2013 None
SEE
PREVIOUS
6/8/2012 ORDER
3/21/2011 None
N/A
6/4/2010 None
8/28/2009 None
N/A
N/A
HOUSTON
KYLE
SURGICAL CRITICAL MOUNT
CARE
PLEASANT
COLON AND RECTAL
SURGERY
HOUSTON
Page 105 of 301
8/26/2013 None
TX
TX
SAN ANTONIO TX
TRAUMATIC
SURGERY
Disciplinary
Status Date
HOUSTON
HOUSTON
THORACIC
CARDIOVASCULAR
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
6/11/2012
N/A
TX
TX
ACTIVE
ACTIVE
8/20/2010 None
9/10/2009 None
N/A
N/A
TX
ACTIVE
11/16/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
4/5/2012 None
N/A
4/13/2012 None
N/A
ACTIVE
ACTIVE
8/9/2013 None
9/21/2010 None
N/A
N/A
BROWNSVILL
E
TX
LUFKIN
TX
License
Number
edicaid
edicaid
End Date
Designated)
N5562
Physician Name
BAVARE, CHARUDATTA SHRIKANT,
MD
P1447
N9511
BAYASI, MOHAMMED , MD
BENJAMIN, ELIZABETH R, MD
P5936
BOGERT, JAMES NATHANIEL, MD
4/1/2013
P0171
BRATVOLD, JARED MICHAEL, MD
7/1/2011
P0172
BREWER, BRYAN DANIEL, MD
7/1/2011
N0661
BROCKER, JASON ANTHONY, MD
8/29/2008
N8379
P6788
BROOKS, STEVEN EDWARD, MD
BROWN, BENTON LEE, MD
1/3/2011
6/3/2013
N8768
P5602
BROWN, NICHOLAS MICHAEL, MD
BURKART, RYAN DANIEL, MD
2/15/2011
3/1/2013
4/9/2010
CAYO, ASHLEY KAPPES, MD
3/15/2013
P2616
N2031
N7787
CHOO, JOSHUA HYOSUNG, MD
CHOUDHRY, VINEET , MD
CIMPEAN, CLAUDIU ADRIAN, MD
4/2/2012
2/6/2009
10/1/2010
P5950
CONNER, JAMES MICHAEL, MD
COVINGTON, CANDACE YVONNE,
MD
DANESHFAR, BAHRAUM DANIEL,
MD
4/1/2013
8/21/2009
8/15/2013
P7630
P6601
DAYE, SUHAIL SAMI, MD
N6252
DEARING, PAUL DAVID, MD
P1464
DEMOLA, SARA MICHELLE, MD
N7248
P2431
DENIZ, SANDRA IVETTE, MD
DESAI, MIT NAVANIT, MD
Practice City
ACTIVE
LICENSE
ISSUED
ACTIVE
11/15/2011 11/15/2016 GENERAL SURGERY
5/2/2011
P5784
N3581
Secondary Specialty
(Self-Designated)
SURGICAL CRITICAL
CARE
Registration
Status of
Practice
Texas
State
License
5/15/2013
6/4/2010
SURGICAL CRITICAL
CARE
HOUSTON
LUBBOCK
FLOWER
MOUND
GENERAL PRACTICE TEMPLE
TRAUMATIC
SURGERY
LUBBOCK
SAN ANGELO
SURGICAL
ONCOLOGY
PLASTIC &
RECONSTRUCTIVE
SURGERY
Disciplinary
Status Date
4/14/2010 None
N/A
11/15/2011 None
6/7/2011 None
N/A
N/A
TX
ACTIVE
4/8/2013 None
N/A
TX
ACTIVE
7/11/2011 None
N/A
TX
ACTIVE
7/7/2011 None
N/A
TX
ACTIVE
9/11/2008 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
1/6/2011 None
6/5/2013 None
N/A
N/A
2/15/2011 None
3/4/2013 None
N/A
N/A
MILWAUKEE
WI
ACTIVE
3/29/2013 None
N/A
AUSTIN
ODESSA
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/9/2012 None
2/11/2009 None
10/11/2010 None
N/A
N/A
N/A
COLON AND RECTAL
SURGERY
TEMPLE
TX
ACTIVE
4/19/2013 None
N/A
HOUSTON
TX
12/4/2009 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
8/15/2013 None
N/A
MASSENA
NY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/23/2013 None
N/A
6/4/2010 None
N/A
11/15/2011 None
N/A
8/5/2010 None
3/21/2012 None
N/A
N/A
ABDOMINAL
SURGERY
11/15/2011 11/15/2016 GENERAL SURGERY
8/2/2010
3/15/2012
Registration
Status Date
Disciplinary
Status of
Texas
License
SULPHUR
SPRINGS
Page 106 of 301
TX
ACTIVE
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
KY
ACTIVE
TX
ACTIVE
P3526
N3021
N6863
DUVALL, DAVID BURL, MD
EMERICK, SCOTT, MD
ENGEL, DELPHINE , MD
6/8/2012
5/29/2009
7/1/2010
N4410
P1753
FENTON, STEPHEN JOSEPH, MD
FITZWATER, JOHN WELTON, MD
FONTENOT, BENNETT BOUSTANY,
MD
11/6/2009
1/2/2012
5/1/2013
GAFFORD, PHILIP SCOTT, MD
GARCIA, STEVEN GARZA, MD
GARZA, AMANDA , MD
GARZA, DELFINO RANDY
ORLANDO, MD
GERRIE, ROBERT DUANE, MD
6/3/2013
5/15/2013
9/17/2012
4/1/2011
5/29/2009
5/29/2009
5/15/2013
N3680
N6879
P5810
P7450
GOALEY, THOMAS JOHN JR, MD
GODINEZ, CARLOS DRAEGER JR,
MD
GONZALEZ, ARTURO GABRIEL ,
MD
GRAHAM, ERIC DUFFEY, MD
GRAHAM, GARY PETER, MD
GRAHAM, PAUL HARDIN, MD
8/21/2009
7/1/2010
3/15/2013
8/1/2013
8/21/2014
7/1/2015
3/15/2018
8/1/2018
P2120
P4450
GRIMM, LEANDER MOREL JR, MD
GUERRA, CRISTINA, MD
2/10/2012
9/17/2012
N5092
GUTTENPLAN, MITCHEL , MD
2/5/2010
N9060
3/15/2011
DALLAS
P3167
P3337
HAFFORD, MELANIE LYNETTE, MD
HAMILTON, FRANCHELL RICHARD,
MD
HANCOCK, HEATHER MAY, MD
5/15/2012
6/1/2012
SAN ANTONIO TX
N7276
HARDEN, WESLEY R III, MD
8/2/2010
P7776
HAYANGA, JEREMIAH WILLIAM, MD
8/30/2013
P2670
HENKE, JEFFREY W, MD
4/2/2012
P6389
P6818
P6618
P4446
N9209
N3047
N3048
P6622
PINEVILLE
LUBBOCK
LACKLAND
AFB
LUBBOCK
PLASTIC SURGERY
SURGICAL
ONCOLOGY
CRITICAL CARE
(SURGERY)
GENERAL SURGERY
GENERAL SURGERY
GENERAL SURGERY
GENERAL SURGERY
Page 107 of 301
Disciplinary
Status Date
6/8/2012 None
6/4/2009 None
7/12/2010 None
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
11/16/2009 None
1/5/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
5/6/2013 None
N/A
MIDLAND
DALLAS
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
7/1/2013 None
5/17/2013 None
9/24/2012 None
N/A
N/A
N/A
4/1/2011 None
6/18/2009 None
N/A
N/A
WACO
TX
JACKSONVILL
E
FL
ACTIVE
7/30/2009 None
N/A
ACTIVE
5/17/2013 None
N/A
KATY
TX
WICHITA
HOUSTON
KS
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
9/1/2009
7/21/2010
4/5/2013
8/5/2013
None
None
None
None
N/A
N/A
N/A
N/A
2/10/2012 None
10/8/2012 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
3/29/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/29/2012 None
6/7/2012 None
N/A
N/A
8/2/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/4/2013 None
N/A
4/2/2012 None
N/A
TX
THORACIC SURGERY
FAMILY PRACTICE
Registration
Status Date
Disciplinary
Status of
Texas
License
ANDREWS
TX
License
Number
P5816
Physician Name
HILL, CHARLES ARTHUR III, MD
edicaid
edicaid
End Date
Designated)
3/15/2013
Secondary Specialty
(Self-Designated)
Practice City
P7123
HIRSCH, BENJAMIN AARON, MD
7/1/2013
P2261
N9227
HODGES, MICHAEL CAMERON, MD
HOWARD, DREW DAVID, MD
3/1/2012
4/1/2011
P3354
HYDE, KELLY VAUGHAN, MD
6/1/2012
P4580
10/1/2012
P2268
ISAACSON, TERAH C, MD
JEANETTE, JOSEPH PATRICK II,
DO
3/1/2012
P2876
JEN, HOWARD CHUNG-HAO, MD
4/13/2012
P6002
JENNINGS, ANDREW WAYNE, MD
4/1/2013
P1465
JOHNSON, VAN ALLAN JR, MD
11/15/2011 11/15/2016 GENERAL SURGERY
N6397
N9229
P7294
N7935
P5198
JOLLY, VALERIE NICOLE, MD
JONES, DONALD VINCENT, MD
KILGORE, JULIE KARNES, MD
KLEPZIG, DALE, MD
KOCH, ERIC B, MD
6/4/2010
4/1/2011
7/15/2013
10/15/2010 10/15/2015 GENERAL SURGERY
1/4/2013
P0843
KOERNER, KATHLEEN MARY, DO
N6433
8/26/2011
KOSS, WEGA, MD
6/4/2010
N9583
KROEKER, TERESA RUTH, MD
5/2/2011
P1559
LAIRD, AMANDA MICHELLE, MD
12/1/2011
P6990
LAMBERT, EDDIE L, MD
6/14/2013
N5182
N4543
N9586
LARSON, CLAIRE RUTH, MD
LAZAR, DAVID ALEXANDER, MD
LE, HOANG LINH, MD
2/5/2010
11/6/2009
5/2/2011
N6457
LENTE, ADELA, MD
6/4/2010
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
CARDIOVASCULAR
SURGERY
AMARILLO
CONROE
TX
TX
COLON AND RECTAL
SURGERY
PEDIATRIC SURGERY
SURGICAL CRITICAL
CARE
DALLAS
HENDERSON
ROCKWALL
PITTSBURG
BIG SPRING
TX
TX
TX
TX
GONZALES
TX
GENERAL SURGERY
HEAD AND NECK
SURGERY
SURGICAL
ONCOLOGY
TEMPLE
COLON AND RECTAL
SURGERY
HOUSTON
GENERAL PRACTICE
Page 108 of 301
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
3/15/2013 None
N/A
ACTIVE
7/23/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/11/2012 None
4/28/2011 None
N/A
N/A
6/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/5/2012 None
N/A
3/1/2012 None
N/A
4/13/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/22/2013 None
N/A
11/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
6/4/2010
4/6/2011
8/13/2013
11/4/2010
1/9/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
9/1/2011 None
N/A
6/4/2010 None
N/A
5/2/2011 None
N/A
12/20/2011 None
N/A
7/12/2013 None
N/A
2/5/2010 None
11/30/2009 None
5/27/2011 None
N/A
N/A
N/A
6/4/2010 None
N/A
License
Number
Physician Name
P0428
LI, LINDA , MD
edicaid
edicaid
End Date
Designated)
7/15/2011
P7799
P2890
P4591
LIANG, MIKE KUO, MD
LIAO, GEORGE PAUL, MD
LOPEZ, SEBASTIAN , MD
8/30/2013
4/13/2012
10/1/2012
P6021
LOUGH, ERIK GREG, MD
4/1/2013
P1784
LUCCHESE, CHRISTOPHER
FRANK, DO
1/2/2012
N1749
N9467
MACFARLANE, JOHN RALPH, MD
MALAVE, VICTOR BRIAN, MD
MALIREDDY, KISHORE KUMAR
P7000
REDDY , MD
N3858
MALLADI, PREETI , MD
P5679
MARTINEZ, MICHAEL JOEL, MD
MARTINEZ-MARTINEZ, ZARAGOZA,
AM00001 MD
N7637
MCALHANEY, MAUREEN SIA, MD
MCKINNEY, WILLIAM BENJAMIN,
J6583
MD
MCTAGUE, MATTHEW MARCUS,
N3176
DO
MEHTA, CHIRAG
P5209
VIRENDRAKUMAR, MD
N6927
MEJIA, JUAN CAMILO, MD
P7811
P7312
MESSICK, CRAIG ALAN, MD
MILAN, STACEY ANNE, MD
N8423
12/12/2008 12/12/2013 GENERAL SURGERY
4/15/2011
6/14/2013
8/21/2009
3/1/2013
10/1/2010
9/1/2010
4/9/2010
5/29/2009
1/4/2013
7/1/2010
8/30/2013
7/15/2013
MINSHALL, CHRISTIAN TODD, MD
1/3/2011
N0985
N5882
MIRANDA, LEONIDAS SANTOS, MD
MOONAT, JOOHEE , MD
8/29/2008
4/9/2010
H3122
P4790
MORGAN, PETER BRIAN, MD
NAGALLA, SUBHASH K S, MD
8/21/2009
11/1/2012
P0859
NAZIM, MUHAMMAD HARIS, MD
8/26/2011
HOUSTON
ROSWELL
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
NM
ACTIVE
AUSTIN
TX
SHERMAN
GENERAL SURGERY BURNET
HOUSTON
Secondary Specialty
(Self-Designated)
ABDOMINAL
SURGERY
FP/OSTEO
MANIPULATION
MEDICINE
Practice City
HOUSTON
8/30/2013 None
4/16/2012 None
11/12/2012 None
N/A
N/A
N/A
ACTIVE
4/17/2013 None
N/A
TX
ACTIVE
2/2/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
1/21/2009 None
5/2/2011 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
7/3/2013 None
8/26/2009 None
3/25/2013 None
N/A
N/A
N/A
10/1/2010 None
9/20/2010 None
N/A
N/A
FL
ACTIVE
4/21/2010 None
N/A
TX
ACTIVE
6/8/2009 None
N/A
2/14/2013 None
N/A
7/1/2010 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
8/30/2013 None
7/25/2013 None
N/A
N/A
DALLAS
TX
ACTIVE
1/17/2011 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
9/8/2008 None
4/26/2010 None
N/A
N/A
BEAUMONT
PEORIA
TX
IL
ACTIVE
ACTIVE
LICENSE
ISSUED
10/22/2009 None
11/7/2012 None
N/A
N/A
8/26/2011 None
N/A
DALLAS
TX
OTHER SPECIALTY
GENERAL SURGERY LUTZ
CONROE
COLON AND RECTAL
SURGERY
CRITICAL CARE
(SURGERY)
VASCULAR
SURGERY
OTHER SPECIALTY
TRAUMATIC
8/26/2016 GENERAL SURGERY SURGERY
Page 109 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/22/2011 None
N/A
Physician Name
edicaid
edicaid
End Date
Designated)
P0106
N1798
N7729
NEEDHAM, JACK NEWTON JR, MD
NELSON, WAYNE KENT, MD
NGUYEN, MINH T, MD
6/15/2011
12/12/2008 12/12/2013 GENERAL SURGERY
9/15/2010
N3949
NIEN SHY, YIH-DAR, MD
License
Number
P1005
NUNEZ, TIMOTHY CHARLES, MD
P1799
P5859
OBOKHARE, IZI DANIEL, MD
OCHOA, ROBERT ANTHONY JR,
MD
OPPELTZ, RICHARD, MD
OSMAN, HOUSSAM GALAL ELDIN,
MD
N8554
N3225
P3407
OWEIS, THOMAS DANIEL, MD
PALMER, LOLITA VERNETTE, MD
PAPAILA, ELIZABETH M, MD
N1808
P7016
8/21/2009
9/15/2011
1/2/2012
3/15/2013
1/18/2011
5/29/2009
6/1/2012
8/30/2013
N7475
N3987
PATEL, VIVEK, MD
PEEL, GARRETT KEITH, MD
PETERSON, RICHARD MATTHEW ,
MD
8/16/2010
8/21/2009
11/6/2009
P4498
PFLUKE, JASON MICHAEL, MD
PHATAK, UMA R, MD
POMMERENING, MATTHEW
JAMES, MD
N5950
N3252
N7740
DALLAS
HOUSTON
CRITICAL CARE
FORT SAM
(SURGERY)
HOUSTON
COLON AND RECTAL
SURGERY
TX
12/12/2008 12/12/2013 GENERAL SURGERY
6/14/2013
PATEL, SHITEL DINESHBHAI, MD
N6580
P1208
Practice City
P7832
N4664
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
ABDOMINAL
SURGERY
TRAUMATIC
SURGERY
PLASTIC &
RECONSTRUCTIVE
SURGERY
THORACIC
CARDIOVASCULAR
SURGERY
6/4/2010
10/17/2011 10/17/2016 GENERAL SURGERY
9/17/2012
PRADHAN, KUMUDA RANJAN, MD
PRIMOMO, JOHN ANTHONY , MD
4/9/2010
5/29/2009
PRZYBYLA, JEFFREY ALAN, MD
9/15/2010
Page 110 of 301
Disciplinary
Status Date
6/15/2011 None
2/9/2009 None
9/22/2010 None
N/A
N/A
N/A
11/19/2009 None
N/A
ACTIVE
9/30/2011 None
N/A
ACTIVE
1/6/2012 None
N/A
ACTIVE
ACTIVE
12/29/2008 None
6/27/2013 None
N/A
N/A
DALLAS
TX
ACTIVE
3/29/2013 None
N/A
MAUMEE
OH
PLANO
TX
ACTIVE
ACTIVE
ACTIVE
2/7/2011 None
8/31/2009 None
6/29/2012 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
9/3/2013 None
N/A
TYLER
BEAUMONT
LACKLAND
AFB
TX
TX
ACTIVE
ACTIVE
8/23/2010 None
8/27/2009 None
N/A
N/A
TX
11/16/2009 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
6/4/2010 None
10/19/2011 None
N/A
N/A
HOUSTON
TX
9/24/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/9/2010 None
6/16/2009 None
N/A
N/A
CONROE
TX
ACTIVE
9/21/2010 None
N/A
OTHER SPECIALTY
TRAUMATIC
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
P7545
P2761
Physician Name
QUINN, BRENDON MICHAEL, MD
QUINN, COURTNEY ELIZABETH,
MD
N8565
RAZA, HYDER , MD
P4699
REDCROSS, JOSEPH II, DO
N9769
P7553
edicaid
edicaid
End Date
Designated)
8/1/2013
4/2/2012
1/18/2011
5/16/2011
8/1/2013
P3423
6/1/2012
P5563
N9771
RIZZO, ANNE GRACE, MD
ROESER, MARK ELLIOT, MD
2/8/2013
5/16/2011
N5980
N4713
ROOT, JEFFREY ROBERT, MD
ROSHEK, THOMAS BANCROFT III,
MD
6/15/2011
4/9/2010
P0670
P5128
P5128
P5128
SAHARIA, ASHISH , MD
SALZMAN, CHRISTOPHER
WILLARD VINCENT, MD
SAMBANDAM, BALAGURU , MD
11/6/2009
N4719
SANDERS, JAMES MITCHELL, MD
11/6/2009
P2062
N4069
2/1/2012
8/21/2009
N5515
SANTAROSA, JULIANNE , MD
SAVU, MICHELLE K, MD
SCHNIEDERJAN, MATTHEW BLEU,
MD
4/9/2010
P0134
SEE, CRAIG STEPHEN, MD
6/15/2011
P3073
SHADDIX, KYLE KIT, MD
5/1/2012
Practice City
PARIS
TX
THORACIC
CARDIOVASCULAR
SURGERY
10/15/2012 10/15/2017 GENERAL SURGERY
REGNER, JUSTIN LEE, MD
REID, NICOLE L, MD
RENDON GARCIA, JUAN JESUS,
MD
P0124
Secondary Specialty
(Self-Designated)
UNDERSEA AND
HYPERBARIC MED
(PREV MED)
Registration
Status of
Practice
Texas
State
License
CRITICAL CARE
(SURGERY)
CRITICAL CARE
(SURGERY)
TRAUMATIC
SURGERY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/15/2013 None
N/A
4/2/2012 None
N/A
1/18/2011 None
N/A
ORANGEBURG SC
ACTIVE
10/18/2012 None
N/A
TEMPLE
HILLSBORO
TX
TX
ACTIVE
ACTIVE
5/27/2011 None
8/19/2013 None
N/A
N/A
MCALLEN
WICHITA
FALLS
TX
ACTIVE
6/8/2012 None
N/A
TX
ACTIVE
ACTIVE
2/18/2013 None
5/24/2011 None
N/A
N/A
LICENSE
ISSUED
6/15/2011 None
N/A
GENERAL VASCULAR
SURGERY
DALLAS
TX
ACTIVE
4/16/2010 None
N/A
SUGARLAND
TX
ACTIVE
12/14/2009 None
N/A
SAN ANTONIO
DALLAS
DALLAS
DALLAS
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
COSMETIC SURGERY DALLAS
TX
SAN ANTONIO TX
TRANSPLANT
SURGERY
8/1/2011
12/17/2012 12/17/2017 GENERAL SURGERY
12/17/2012 12/17/2017 GENERAL SURGERY
12/17/2012 12/17/2017 GENERAL SURGERY
DALHART
Page 111 of 301
TX
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
2/8/2010 None
N/A
ACTIVE
ACTIVE
2/3/2012 None
9/15/2009 None
N/A
N/A
5/3/2010 None
N/A
6/15/2011 None
N/A
5/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/25/2011
1/7/2013
1/7/2013
1/7/2013
Physician Name
edicaid
edicaid
End Date
Designated)
P1493
SHIFFLETTE, VANESSA KIANA, MD
11/15/2011 11/15/2016 GENERAL SURGERY
P5237
P0498
N8151
SHORT, TRACEE C, MD
SINGH, MANISH, MD
STARNES, CODY , MD
1/4/2013
7/15/2011
11/15/2010 11/15/2015 GENERAL SURGERY
N8463
STUART, GILLIAN JOSEPHINE, MD
1/3/2011
N6058
P0308
TAMEZ, ANGEL JOSE, MD
TAPIA, NICOLE MARIE, MD
4/9/2010
7/1/2011
N7755
TESTA, GIULIANO , MD
9/15/2010
N6718
6/4/2010
N9001
N4803
TIEU, KENNETH KHIEM, MD
TORO-SERRA, RAFAEL ORLANDO,
MD
TORRES BARJA, IUMY, MD
N2852
N6734
License
Number
3/1/2011
11/6/2009
TRUSSELL, JOSHUA KYLE, MD
4/3/2009
TYNER, RYAN PATRICK, MD
6/4/2010
N9658
N1937
TYSON, GEORGE HART III, MD
VARGAS, DANIEL , MD
N6747
VASQUEZ, ISELA, MD
J0343
P3266
WALTHALL, ELLEN DELOY, MD
5/2/2011
12/12/2008 12/12/2013 GENERAL SURGERY
6/4/2010
11/6/2009
Secondary Specialty
(Self-Designated)
TRAUMATIC
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
COSMETIC SURGERY
MCALLEN
HOUSTON
TRANSPLANT
SURGERY
CHICAGO
TX
TX
IL
HEAD AND NECK
SURGERY
TRAUMATIC
SURGERY
TRAUMATIC
SURGERY
GREENVILLE
TX
HOUSTON
TX
SAN ANTONIO TX
5/15/2012
P5577
P0321
WASHER, JOSHUA DANIEL, MD
WETHERILL, TIMOTHY
FARRINGTON, MD
WILLIAMS, DEREK EDWIN, MD
2/8/2013
7/1/2011
P3680
WILLIAMS, FELICIA NICOLE, MD
6/15/2012
P4835
WOOD, JAMES HUNTER, MD
11/1/2012
N4849
N3393
WOOTEN, ERIC T., DO
WORLEY, TODD ANTHONY , MD
11/6/2009
5/29/2009
TRANSPLANT
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
11/24/2011 None
N/A
1/4/2013 None
8/16/2011 None
11/18/2010 None
N/A
N/A
N/A
1/3/2011 None
N/A
4/9/2010 None
7/12/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/22/2010 None
N/A
6/4/2010 None
N/A
3/1/2011 None
12/4/2009 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/20/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/10/2011 None
1/7/2009 None
N/A
N/A
6/4/2010 None
N/A
11/16/2009 None
N/A
SWEETWATE
R
TX
ACTIVE
DALLAS
TX
5/18/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/8/2013 None
7/29/2011 None
N/A
N/A
TX
ACTIVE
6/29/2012 None
N/A
TX
ACTIVE
11/2/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
12/9/2009 None
6/8/2009 None
N/A
N/A
SURGICAL CRITICAL
CARE
GALVESTON
PEDIATRIC SURGERY DALLAS
TRAUMATIC
11/6/2014 GENERAL SURGERY SURGERY
BEAUMONT
HOUSTON
Page 112 of 301
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P3599
P0811
YOUNES, HOUSSAM KHALED, MD
ZAMORA, IRVING JOSE, MD
P3290
BIETZ, GABRIEL JACKSON, MD
6/1/2012
GENERAL VASCULAR
6/1/2017 SURGERY
N6456
LEE, RICHARD WALKER, MD
6/4/2010
GENERAL VASCULAR
6/4/2015 SURGERY
P1031
9/15/2011
GENERAL VASCULAR
9/15/2016 SURGERY
N7216
WEST, CHARLES ADGER JR, MD
BARBARO DIEBER, TINA GRACE,
MD
N8918
GENTRY, JERRY L II, MD
N8280
CHAVA, PRAVEEN, MD
12/15/2010
P7453
HAGIWARA, YUYA , MD
8/1/2013
P1469
LIETO, JANET, DO
P3383
LUM, ALBERT WAI-MING, MD
6/1/2012
P6905
ROSALEZ, MISSY NEDA, MD
6/3/2013
N6784
YOUNG, KAVON LYNETTE, MD
6/4/2010
P5930
4/1/2013
P5052
BALAPALA, KIRANMAYE , MD
CHITWOOD, DARCIE ANDERSON,
DO
DO
DO
N7547
HOMMEL, ERIN LEIGH, MD
P3019
KIM, JUNG-HOON, MD
P5052
P5052
6/8/2012
8/15/2011
8/2/2010
3/1/2011
11/15/2011
12/17/2012
12/17/2012
12/17/2012
8/27/2010
5/1/2012
Secondary Specialty
(Self-Designated)
VASCULAR
SURGERY
Practice City
HOUSTON
TX
VASCULAR
SURGERY
8/2/2015 GENETICS
3/1/2016 GENETICS
GERIATRIC MEDICINE
12/15/2015 (FAMILY PRACTICE)
GERIATRIC MEDICINE
GERIATRIC MEDICINE
GERIATRIC MEDICINE
GERIATRIC MEDICINE
GERIATRIC MEDICINE
GERIATRIC MEDICINE
4/1/2018 (INTERNAL MED)
GERIATRIC MEDICINE
GERIATRIC MEDICINE
GERIATRIC MEDICINE
GERIATRIC MEDICINE
GERIATRIC MEDICINE
Registration
Status of
Practice
Texas
State
License
FAMILY PRACTICE
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
6/11/2012 None
8/29/2011 None
N/A
N/A
LICENSE
ISSUED
6/1/2012 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
ACTIVE
11/14/2011 None
N/A
HOUSTON
TX
THE
WOODLANDS TX
ACTIVE
8/23/2010 None
N/A
ACTIVE
LICENSE
ISSUED
3/16/2011 None
N/A
12/15/2010 None
N/A
SIOUX FALLS
SD
ACTIVE
8/7/2013 None
N/A
FORT WORTH TX
ACTIVE
11/30/2011 None
N/A
ACTIVE
6/11/2012 None
N/A
ACTIVE
LICENSE
ISSUED
6/12/2013 None
N/A
6/4/2010 None
N/A
LUBBOCK
TX
FAMILY MEDICINE
FAMILY MEDICINE
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
Disciplinary
Status Date
TX
FAMILY MEDICINE
FAMILY PRACTICE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
GALVESTON
TX
ACTIVE
4/8/2013 None
N/A
SAN ANGELO
TX
ACTIVE
12/19/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/19/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/19/2012 None
N/A
TX
ACTIVE
9/6/2010 None
N/A
TX
ACTIVE
5/3/2012 None
N/A
Page 113 of 301
License
Number
Physician Name
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
GERIATRIC
7/1/2011
7/1/2016 PSYCHIATRY
PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
Practice City
ALBUQUERQU
E
NM
H8781
ORTIZ, IRENE ELIZABETH, MD
P2831
N2028
BOCIRNEA, CRISTINA, MD
CHEEMA, FAISAL NAWAZ, MD
4/13/2012
2/6/2009
4/13/2017 GERIATRICS
2/6/2014 GERIATRICS
INTERNAL MEDICINE
TX
N0953
MATHAVAN, RAJEEV KUMAR, MD
8/29/2008
TX
N8696
N7166
2/4/2011
7/15/2010
11/15/2012
INTERNAL MEDICINE LUBBOCK
NEW HYDE
GERIATRICS
PARK
TX
TX
P4842
NGO, BICH-THY NGUYEN, MD
RHODES, RAMONA , MD
ADEYEMO, VIVIAN
OGHENEVWEDE, MD
ACTIVE
LICENSE
ISSUED
ACTIVE
NY
N7254
EUBANK, KATHRYN JEAN, MD
8/2/2010
P1079
10/3/2011
P2886
GREEN, AVAL-NA'REE SIAN, MD
KUTAGULA, VINAY
VENGAREDDIGARI, MD
P2842
CRANE, ERIN KING, MD
4/13/2012
4/13/2012
P3528
FARZAN, THAHIR , MD
N3784
KEHOE, SIOBHAN MARIE, MD
P6032
MCCORMICK, TIMOTHY CHAD, DO
4/1/2013
P4595
MIROSHNICHENKO, GENNADY, MD
10/1/2012
N8332
PADILLA, LUIS ALFONSO, MD
P5749
TWIGGS, LEO BROOKHART, MD
3/1/2013
N5453
VASQUES, DEETTE RAY, DO
2/5/2010
P0371
P5899
DERESKA, NINA HOLTZAPPLE, MD
TOWBIN, NANCY ANDES, MD
P2743
NEAMAN, KEITH C, MD
6/8/2012
8/21/2009
12/15/2010
7/15/2011
3/15/2013
4/2/2012
2/4/2016 GERIATRICS
GERIATRICS 11/15/2017 INTERNAL MEDICINE
GYNECOLOGIC
4/13/2017 ONCOLOGY
GYNECOLOGIC
6/8/2017 ONCOLOGY
GYNECOLOGIC
8/21/2014 ONCOLOGY
GYNECOLOGIC
4/1/2018 ONCOLOGY
GYNECOLOGIC
10/1/2017 ONCOLOGY
GYNECOLOGIC
12/15/2015 ONCOLOGY
GYNECOLOGIC
3/1/2018 ONCOLOGY
GYNECOLOGIC
2/5/2015 ONCOLOGY
7/15/2016 GYNECOLOGY
4/2/2017 HAND SURGERY
PALLIATIVE
MEDICINE
GYNECOLOGIC
SURGERY
GYNECOLOGY
GYNECOLOGIC
SURGERY
UROGYNECOLOGY
PLASTIC &
RECONSTRUCTIVE
SURGERY
Page 114 of 301
Disciplinary
Status Date
8/1/2011 None
N/A
4/13/2012 None
2/16/2009 None
N/A
N/A
9/12/2008 None
N/A
2/4/2011 None
7/27/2010 None
N/A
N/A
ACTIVE
12/31/2012 None
N/A
TX
ACTIVE
8/12/2010 None
N/A
TEMPLE
TX
ACTIVE
10/5/2011 None
N/A
ADDISON
TX
ACTIVE
4/24/2012 None
N/A
HOUSTON
TX
ACTIVE
4/17/2012 None
N/A
AMARILLO
TX
ACTIVE
6/11/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
10/2/2009 None
N/A
4/1/2013 None
N/A
FORT WORTH TX
ACTIVE
10/4/2012 None
N/A
EL PASO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/22/2010 None
N/A
3/1/2013 None
N/A
2/5/2010 None
N/A
WEBSTER
FULLERTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
CA
ACTIVE
ACTIVE
7/25/2011 None
4/8/2013 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
4/3/2012 None
N/A
License
Number
Physician Name
P4713
SHUHATOVICH, YEVGENY, DO
P3124
BOLSON, RAJSHRI MAHESHWARI,
MD
N9218
HECOX, SCOTT EDWARD, MD
P4872
HUNT, THOMAS R III, MD
P6670
LARSON, TIMOTHY BRAD, MD
P6861
LONGHOFER, LISA KAY, MD
P2320
NGUYEN, MINH DUC, MD
N8834
PATTERSON, RYAN WILLIAM, MD
edicaid
edicaid
End Date
Designated)
10/15/2012 10/15/2017 HAND SURGERY
HAND SURGERY ORTHOPEDIC
5/15/2012
5/15/2017 SURGERY
4/1/2011
4/1/2016 SURGERY
11/15/2012 11/15/2017 SURGERY
5/15/2013
5/15/2018 SURGERY
6/3/2013
6/3/2018 SURGERY
3/1/2012
3/1/2017 SURGERY
2/15/2011
2/15/2016 SURGERY
6/4/2010
6/4/2015 SURGERY
6/4/2010
6/4/2015 SURGERY
6/4/2010
6/4/2015 SURGERY
N6607
REARDON, RYAN SCOTT, MD
N6610
REICHEL, LEE M, MD
N6712
TEUNIS, CANDICE BRAERMAN, MD
P7139
KUHLMAN-WOOD, KATE ASHLI, MD
7/1/2013
N7868
SAMMER, DOUGLAS MICHAEL, MD
10/1/2010
N7548
JACOB, SHUSHAN, MD
8/27/2010
HAND SURGERY 7/1/2018 PLASTIC SURGERY
HAND SURGERY 10/1/2015 PLASTIC SURGERY
HAND SURGERY 8/27/2015 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
GENERAL SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
10/29/2012 None
N/A
SD
ACTIVE
5/21/2012 None
N/A
SAN ANTONIO TX
ACTIVE
4/22/2011 None
N/A
ORTHOPEDIC
SURGERY
HOUSTON
TX
ACTIVE
11/20/2012 None
N/A
ORTHOPEDICS
CINCINNATI
OH
ACTIVE
5/23/2013 None
N/A
ORTHOPEDIC
SURGERY
SAN ANTONIO TX
ACTIVE
6/11/2013 None
N/A
ORTHOPEDIC
SURGERY
RAPID CITY
ORTHOPEDICS
LICENSE
ISSUED
3/1/2012 None
N/A
ORTHOPEDIC
SURGERY
LICENSE
ISSUED
2/15/2011 None
N/A
ORTHOPEDIC
SURGERY
LICENSE
ISSUED
6/4/2010 None
N/A
ORTHOPEDICS
LICENSE
ISSUED
6/4/2010 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
ORTHOPEDIC
SURGERY
SURGERY
PLASTIC &
RECONSTRUCTIVE
SURGERY
Page 115 of 301
HOUSTON
TX
ACTIVE
7/11/2013 None
N/A
DALLAS
TX
ACTIVE
10/11/2010 None
N/A
DALLAS
TX
ACTIVE
9/6/2010 None
N/A
License
Number
Physician Name
N8538
LYLES, JAMES EDWARD JR, MD
N8220
MCKEE, DESIRAE , MD
P7442
GALLAGHER, KATHLEEN KELLY,
MD
N6151
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
Practice City
HAND SURGERY 1/18/2011
1/18/2016 SURGERY
HAND SURGERY 12/1/2010
12/1/2015 SURGERY
GENERAL SURGERY LUBBOCK
8/1/2013
6/4/2010
P3517
AUSTIN, NED ALVIN, MD
CASTRO-SILVA, FERNANDO
JAVIER, MD
P5974
FELDMAN, LILIYA, MD
4/1/2013
N9757
ONCIU, MIHAELA , MD
5/16/2011
6/8/2012
P1617
APONTE, EMMALIND, MD
12/15/2011
P6575
ARMAGHANY, TANNAZ, MD
N5563
BAYRAKTAR, ULAS DARDA, MD
P1166
BHAT, ASHWINI, MD
N6197
P6595
BUENO HUME, CELYNE, MD
CAMPBELL, MATTHEW THOMAS,
MD
P5946
CHOI, SUNG-HEE, MD
N4352
CISNEROS, LAURA E, MD
N1590
CIUREA, STEFAN OCTAVIAN, MD
P0031
DAVER, NAVAL GUSTAD, MD
6/15/2011
P1538
12/1/2011
P2851
DELRIE, RONALD DWAYNE JR, MD
DINARDO, COURTNEY DENTON,
MD
N9363
DODDABELE, SUDARSHAN R, MD
4/8/2011
5/15/2013
4/9/2010
10/17/2011
6/4/2010
5/15/2013
4/1/2013
11/6/2009
12/12/2008
4/13/2012
HEAD AND NECK
OTOLARYN & FACIAL
8/1/2018 SURGERY
PLASTIC SURGERY
HEMATOLOGY
6/4/2015 (PATHOLOGY)
HEMATOLOGY
PATHOLOGY
HEMATOLOGY
ANATOMIC/CLINICAL
PATHOLOGY
HEMATOLOGY
ANATOMIC
PATHOLOGY
HEMATOLOGY/ONCOL HEMATOLOGY/ONCO
12/15/2016 OGY
LOGY
HEMATOLOGY/ONCOL
5/15/2018 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
4/9/2015 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
10/17/2016 OGY
HEMATOLOGY/ONCOL
6/4/2015 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
5/15/2018 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
4/1/2018 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
11/6/2014 OGY
HEMATOLOGY/ONCOL
12/12/2013 OGY
HEMATOLOGY/ONCOL
6/15/2016 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
12/1/2016 OGY
HEMATOLOGY/ONCOL
4/13/2017 OGY
ONCOLOGY
HEMATOLOGY/ONCOL
4/8/2016 OGY
INTERNAL MEDICINE
Page 116 of 301
HOUSTON
DALLAS
ELMWOOD
PARK
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
1/31/2011 None
N/A
TX
ACTIVE
1/11/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/9/2013 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
6/18/2012 None
N/A
NJ
ACTIVE
LICENSE
ISSUED
4/12/2013 None
N/A
5/16/2011 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
1/6/2012 None
N/A
HOUSTON
TX
ACTIVE
7/15/2013 None
N/A
MIAMI
FL
ACTIVE
4/26/2010 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
10/25/2011 None
N/A
6/4/2010 None
N/A
HOUSTON
TX
ACTIVE
5/22/2013 None
N/A
DALLAS
TX
ACTIVE
4/3/2013 None
N/A
HARLINGEN
TX
ACTIVE
11/16/2009 None
N/A
HOUSTON
TX
ACTIVE
3/3/2009 None
N/A
HOUSTON,
TX
ACTIVE
6/20/2011 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
1/23/2012 None
N/A
4/13/2012 None
N/A
ACTIVE
4/18/2011 None
N/A
SIOUX CITY
IA
License
Number
Physician Name
N7919
EL FAKIH, RIAD OMAR, MD
P5062
EWING, JAMES I, MD
P5062
EWING, JAMES I, MD
P5062
EWING, JAMES I, MD
N9055
GAO, JIANJUN , MD
N1326
GEORGE, BENJAMIN JACOB, MD
N6877
GOODGAME, BOONE, MD
N7928
JANA, BAGI RP, MD
N8198
P0238
JOHNSON, WENDY MAHONE, MD
JONES, CORTNEY VANDERBILT,
MD
P2470
KELLY, KEVIN ROBERT, MD
N0881
KHALIL, MAZEN YOUNIS, MD
P3190
LEE, SEUNG TAE , MD
N6460
LIN, WEEI-CHIN, MD
P0627
LIU, DONGXIN, MD
P0083
LIU-DUMLAO, THERESA ONG, MD
P2726
MANKAN, NAGENDER, MD
P7499
MARTE, MICHAEL, MD
N6495
MIRZA, MUHAMMAD AZIM , MD
P6682
MOBAYED, MOHAMMAD, MD
edicaid
edicaid
End Date
Designated)
HEMATOLOGY/ONCOL
10/15/2010 10/15/2015 OGY
HEMATOLOGY/ONCOL
12/17/2012 12/17/2017 OGY
HEMATOLOGY/ONCOL
12/17/2012 12/17/2017 OGY
HEMATOLOGY/ONCOL
12/17/2012 12/17/2017 OGY
HEMATOLOGY/ONCOL
3/15/2011
3/15/2016 OGY
HEMATOLOGY/ONCOL
10/10/2008 10/10/2013 OGY
HEMATOLOGY/ONCOL
7/1/2010
7/1/2015 OGY
HEMATOLOGY/ONCOL
10/15/2010 10/15/2015 OGY
HEMATOLOGY/ONCOL
12/1/2010
12/1/2015 OGY
HEMATOLOGY/ONCOL
7/1/2011
7/1/2016 OGY
HEMATOLOGY/ONCOL
3/15/2012
3/15/2017 OGY
HEMATOLOGY/ONCOL
8/29/2008
8/29/2013 OGY
HEMATOLOGY/ONCOL
5/15/2012
5/15/2017 OGY
HEMATOLOGY/ONCOL
6/4/2010
6/4/2015 OGY
HEMATOLOGY/ONCOL
8/1/2011
8/1/2016 OGY
HEMATOLOGY/ONCOL
6/15/2011
6/15/2016 OGY
HEMATOLOGY/ONCOL
4/2/2012
4/2/2017 OGY
HEMATOLOGY/ONCOL
8/1/2013
8/1/2018 OGY
HEMATOLOGY/ONCOL
6/4/2010
6/4/2015 OGY
HEMATOLOGY/ONCOL
5/15/2013
5/15/2018 OGY
INTERNAL MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
1/14/2013 None
N/A
TX
ACTIVE
1/14/2013 None
N/A
LACKLAND
TX
ACTIVE
3/28/2011 None
N/A
TX
ACTIVE
10/21/2008 None
N/A
INTERNAL MEDICINE KYLE
TX
ACTIVE
7/16/2010 None
N/A
FL
ACTIVE
LICENSE
ISSUED
10/20/2010 None
N/A
12/1/2010 None
N/A
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE
ORLANDO
SAN ANGELO
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/15/2010 None
N/A
12/17/2012 None
N/A
TX
ACTIVE
7/8/2011 None
N/A
SAN ANTONIO TX
HEMATOLOGY/ONCO
LOGY
JONESBORO AR
ACTIVE
3/22/2012 None
N/A
ACTIVE
10/7/2008 None
N/A
HEMATOLOGY INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
5/30/2012 None
N/A
6/4/2010 None
N/A
8/1/2011 None
N/A
6/15/2011 None
N/A
ACTIVE
4/6/2012 None
N/A
ACTIVE
LICENSE
ISSUED
9/2/2013 None
N/A
6/4/2010 None
N/A
5/17/2013 None
N/A
TX
INTERNAL MEDICINE
INTERNAL MEDICINE
EL PASO
TX
INTERNAL MEDICINE
INTERNAL MEDICINE FINDLEY
Page 117 of 301
OH
ACTIVE
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
HEMATOLOGY/ONCOL
P1369
MUNOZ, JAVIER LUIS, MD
11/4/2011
11/4/2016 OGY
HEMATOLOGY/ONCOL
N3923
MUSHER, BENJAMIN, MD
8/21/2009
8/21/2014 OGY
HEMATOLOGY/ONCOL
N6522
NAIR, BINU S, MD
6/4/2010
6/4/2015 OGY
HEMATOLOGY/ONCOL
P6877
NASTOUPIL, LORETTA JO, MD
6/3/2013
6/3/2018 OGY
HEMATOLOGY/ONCOL
N3211
NIRMAL, KAVITA , MD
5/29/2009
5/29/2014 OGY
HEMATOLOGY/ONCOL
P0456
NWAKUCHE, UZOMA , MD
7/15/2011
7/15/2016 OGY
HEMATOLOGY/ONCOL
N5296
OO, THEIN HLAING, MD
2/5/2010
2/5/2015 OGY
HEMATOLOGY/ONCOL
P1122
ORAN, BETUL , MD
10/3/2011
10/3/2016 OGY
HEMATOLOGY/ONCOL
N7734
OU, SAI-HONG IGNATIUS, MD
9/15/2010
9/15/2015 OGY
HEMATOLOGY/ONCOL
P5559
PATEL, NILESH ARVINDBHAI, MD
2/8/2013
2/8/2018 OGY
HEMATOLOGY/ONCOL
P3066
RIVERO, GUSTAVO , MD
5/1/2012
5/1/2017 OGY
HEMATOLOGY/ONCOL
N5977
RODRIGUEZ, JORGE IVAN, MD
4/9/2010
4/9/2015 OGY
SANKHALA, KAMALESH KUMAR,
HEMATOLOGY/ONCOL
N9776
MD
5/16/2011
5/16/2016 OGY
HEMATOLOGY/ONCOL
N8854
SHINWARI, JAVED KHAN, MD
2/15/2011
2/15/2016 OGY
HEMATOLOGY/ONCOL
P3078
SOMAIAH, NEETA, MD
5/1/2012
5/1/2017 OGY
HEMATOLOGY/ONCOL
P1145
SWORDS, RONAN THOMAS, MD
10/3/2011
10/3/2016 OGY
HEMATOLOGY/ONCOL
N8153
UFEARO, HILARY IKENNA, MD
11/15/2010 11/15/2015 OGY
HEMATOLOGY/ONCOL
P6539
UNNI, NISHA, MD
5/1/2013
5/1/2018 OGY
HEMATOLOGY/ONCOL
P5014
YALAMANCHILI, KIRAN KUMAR, MD 11/30/2012 11/30/2017 OGY
HEMATOLOGY/ONCOL
N9666
YI, ZANHUA, MD
5/2/2011
5/2/2016 OGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/10/2011 None
N/A
9/14/2009 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
6/7/2013 None
N/A
ACTIVE
8/5/2009 None
N/A
INTERNAL MEDICINE BAYTOWN
ACTIVE
LICENSE
ISSUED
8/18/2011 None
N/A
2/5/2010 None
N/A
10/20/2011 None
N/A
ACTIVE
LICENSE
ISSUED
10/4/2010 None
N/A
2/8/2013 None
N/A
ACTIVE
6/28/2012 None
N/A
INTERNAL MEDICINE
ACTIVE
4/21/2010 None
N/A
5/18/2011 None
N/A
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
2/15/2011 None
N/A
INTERNAL MEDICINE CHARLESTON SC
ACTIVE
5/10/2012 None
N/A
SAN ANTONIO TX
ACTIVE
10/4/2011 None
N/A
TX
MINNEAPOLIS MN
INTERNAL MEDICINE ORANGE
HOUSTON
CA
TX
ACTIVE
INTERNAL MEDICINE ST CLOUD
MN
ACTIVE
12/27/2010 None
N/A
TX
ACTIVE
5/13/2013 None
N/A
NY
ACTIVE
12/4/2012 None
N/A
TX
ACTIVE
6/8/2011 None
N/A
CORTLAND
Page 118 of 301
License
Number
Physician Name
P2936
ZHANG, JIANJUN , MD
P4841
ZHU, HAO, MD
N6309
N5797
GAUTAM, MANJUSHREE, MD
LANDAVERDE, CARMEN ELENA,
MD
N0912
LARSON, ANNE MARIE, MD
N9912
MODI, APURVA ASHOK, MD
N6556
PAN, JEN-JUNG, MD
N6666
SINGAL, AMIT, MD
N7014
TUJIOS, SHANNAN RENEE, MD
P7593
VICTOR, DAVID W III, MD
N4198
P2086
P6942
WELLS, JENNIFER TATUM , MD
XIE, BINGRU, MD
AJIBADE, OLUWASEUN AKINWALE,
MD
P0333
ALAUDDIN, KASHIF, MD
P6315
P3281
ALEMU, BENYAM GIZACHEW, MD
ANDERSON, ROBERT WESLEY III,
MD
ANUKAM, UZOESHI IHEANACHO,
MD
P4412
ANWAR, ZESHAN, MD
P2578
ARIF, FARHAN AHMAD, MD
P6132
ATALLAH, RABIH, MD
L9071
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
HEMATOLOGY/ONCOL
4/13/2012
4/13/2017 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
11/1/2012
11/1/2017 OGY
INTERNAL MEDICINE
GASTROENTEROLOG
6/4/2010
6/4/2015 HEPATOLOGY
Y
GASTROENTEROLOG
4/9/2010
4/9/2015 HEPATOLOGY
Y
GASTROENTEROLOG
8/29/2008
8/29/2013 HEPATOLOGY
Y
GASTROENTEROLOG
6/3/2011
6/3/2016 HEPATOLOGY
Y
GASTROENTEROLOG
6/4/2010
6/4/2015 HEPATOLOGY
Y
GASTROENTEROLOG
6/4/2010
6/4/2015 HEPATOLOGY
Y
GASTROENTEROLOG
7/1/2010
7/1/2015 HEPATOLOGY
Y
GASTROENTEROLOG
8/1/2013
8/1/2018 HEPATOLOGY
Y
GASTROENTEROLOG
8/21/2009
8/21/2014 HEPATOLOGY
Y
2/1/2012
2/1/2017 HEPATOLOGY
INTERNAL MEDICINE
Practice City
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/13/2012 None
N/A
ACTIVE
LICENSE
ISSUED
11/8/2012 None
N/A
6/4/2010 None
N/A
DALLAS
TX
ACTIVE
4/14/2010 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
9/22/2008 None
N/A
6/3/2011 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/21/2010 None
N/A
8/1/2013 None
N/A
ACTIVE
ACTIVE
8/25/2009 None
2/13/2012 None
N/A
N/A
DALLAS
DALLAS
6/14/2013
6/14/2018 HOSPITALIST
INTERNAL MEDICINE
7/15/2011
INTERNAL MEDICINE
5/1/2013
INTERNAL MEDICINE
2/8/2013
INTERNAL MEDICINE DENTON
6/1/2012
INTERNAL MEDICINE DYERSBURG
9/17/2012
4/2/2012
4/12/2013
Page 119 of 301
Registration
Status of
Practice
Texas
State
License
LICENSE
TX
ISSUED
TX
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/1/2013 None
N/A
7/15/2011 None
N/A
5/1/2013 None
N/A
TX
ACTIVE
2/21/2013 None
N/A
TN
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
LICENSE
ISSUED
6/27/2012 None
N/A
12/16/2012 None
N/A
4/2/2012 None
N/A
4/12/2013 None
N/A
License
Number
edicaid
edicaid
End Date
Designated)
DALLAS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
MI
ACTIVE
OK
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
HUMBLE
TX
ACTIVE
11/17/2009 None
N/A
HOUSTON
TX
ACTIVE
4/18/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
8/20/2010 None
N/A
6/4/2010 None
4/14/2011 None
4/9/2012 None
N/A
N/A
N/A
8/2/2010 None
N/A
Secondary Specialty
(Self-Designated)
P7608
Physician Name
BADIREDDY, MADHU SUDHAN
REDDY, MD
P5027
BANDA, PRAGATI, MD
12/17/2012 12/17/2017 HOSPITALIST
P5027
BANDA, PRAGATI, MD
12/17/2012 12/17/2017 HOSPITALIST
P5027
P4735
N0631
BANDA, PRAGATI, MD
BANTU, VISHWAROOP, MD
BARAKAT, AYMAN , MD
12/17/2012 12/17/2017 HOSPITALIST
11/1/2012
8/29/2008
P2595
P0958
BEVINAL, MANZOOR AHAMED, MD
BHATTARAI, SUMIT, MD
4/2/2012
9/15/2011
N4297
BHODA, RAJA SEKHAR REDDY, MD
11/6/2009
N9356
BRITO-DELLAN, NORMAN, MD
4/8/2011
FAMILY MEDICINE
PALLIATIVE
MEDICINE
N7234
BURGUENO, JORGE ENRIQUE, MD
8/2/2010
N6202
N9357
P2604
6/4/2010
4/8/2011
4/2/2012
8/2/2010
N9031
N1602
P6375
N9695
BURTON, MICHAEL ELLIOT, MD
BYRD, TIMOTHY MICHAEL, MD
CARABALLO, AIXA, MD
CHENNAMANENI, RAJNARSING
RAO, MD
CHERUIYOT, HONEY CHEMUTAI,
MD
DAGOSTINO, JANET LYNN, DO
DEVAGIRI, MADHAVI, MD
DOAN, ELLIS, MD
N3631
P5623
ELMAHI, NADEAR ABDURAHMAN
GORASHI , MD
ESUZOR, LINDA CHIBUZOR, MD
N7240
P6816
P0384
N4422
N8296
N7093
FLETCHER, JEFFREY CLAY JR, DO
GADAM, MOHAN RAVINDRA, MD
GEDDES-SILVA, SHANNON MARIE ,
MD
GIBSON, RACHELE ANN, MD
GOGINENI, SRIKANTH, MD
8/15/2013
3/15/2011
12/12/2008 12/12/2013 HOSPITALIST
5/1/2013
5/16/2011
Practice City
INTERNAL MEDICINE
KALAMAZOO
INTERNAL MEDICINE TULSA
TEMPLE
AUSTIN
TX
TX
INTERNAL MEDICINE
INTERNAL MEDICINE IRVING
FAMILY MEDICINE
SAN ANGELO
INTERNAL MEDICINE SAN ANTONIO
AUSTIN
TX
TX
TX
TX
8/21/2009
3/1/2013
INTERNAL MEDICINE
6/3/2013
7/15/2011
FAMILY PRACTICE
11/6/2009
12/15/2010 12/15/2015 HOSPITALIST
7/15/2010
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DELINQUEN
T-NON
PAYMENT
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/15/2013 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
11/15/2012 None
11/19/2008 None
N/A
N/A
N/A
4/2/2012 None
12/7/2011 None
N/A
N/A
4/19/2011
12/29/2008
5/3/2013
5/19/2011
None
None
None
None
N/A
N/A
N/A
N/A
11/19/2009 None
3/25/2013 None
N/A
N/A
SAN ANTONIO TX
AUSTIN
TX
ACTIVE
ACTIVE
7/3/2013 None
7/21/2011 None
N/A
N/A
INTERNAL MEDICINE
TX
Page 120 of 301
ACTIVE
ACTIVE
ACTIVE
1/11/2010 None
12/29/2010 None
7/21/2010 None
N/A
N/A
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
HOSPITALIST
HOSPITALIST
HOSPITALIST
HOSPITALIST
HOSPITALIST
HOSPITALIST
HOSPITALIST
Secondary Specialty
(Self-Designated)
Practice City
P7449
P0391
P0980
P5983
P7772
P7455
P5376
GOODSETT, JAMES ROBERT, MD
GOVATHOTI, DEEPTI A, MD
GRECO, PAUL THOMAS, MD
GUPTA, MOHIT, MD
HAILE, ISRAEL, MD
HAMBY, RICKEY WHITE JR, MD
HAUCK, MICHELLE MARIE, MD
8/1/2013
7/15/2011
9/15/2011
4/1/2013
8/30/2013
8/1/2013
2/1/2013
8/1/2018
7/15/2016
9/15/2016
4/1/2018
8/30/2018
8/1/2018
2/1/2018
N6348
P4459
HEALY, JENNIFER MARIE, DO
HIREMATH, ADARSH, MD
6/4/2010
9/17/2012
N7107
P2009
P6429
HUAMAN VARGAS, GONZALO, MD
IBARRA, JOHN ISIDRO, MD
IMIERE, EDWIN OLATUNJI, MD
7/15/2010
2/1/2012
5/1/2013
P3007
P3357
5/1/2012
6/1/2012
P0609
P5089
P5089
P5089
IQBAL, MOHAMMED S, MD
JACOB, SURAJ, MD
JAVIER, EDUARDO PASMAN JR,
MD
JEPPSON, JOSEPH JEPPA, DO
INTERNAL MEDICINE HUMBLE
LUBBOCK
INTERNAL MED PEDS
DALLAS
8/1/2011
12/17/2012 12/17/2017 HOSPITALIST
12/17/2012 12/17/2017 HOSPITALIST
12/17/2012 12/17/2017 HOSPITALIST
INTERNAL MEDICINE
INTERNAL MEDICINE WAILUKU
N5132
JOGLEKAR, SAMIR, MD
2/5/2010
N5133
JOGLEKAR, SWATI, MD
2/5/2010
N6403
KALU, IFEOMA A, MD
6/4/2010
N7819
P4771
KARNCHANASORN, SOPHANA , MD
KAZIE, NELSON, MD
10/1/2010
11/1/2012
INTERNAL MEDICINE
P5541
N7120
KHADIMALLY, KHAWER PASHA, DO
KHAN, KIRAN NAWAZ, MD
2/8/2013
7/15/2010
INTERNAL MEDICINE
P5394
N1365
KHAN, MEHWISH AMIR, MD
KILARU, DEEPIKA , MD
P6436
N9885
KOLLI, SARITHA, DO
KOLLI, VIJAY KUMAR, MD
2/1/2013
10/10/2008 10/10/2013 HOSPITALIST
5/1/2013
6/3/2011
FAMILY PRACTICE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
FAMILY MEDICINE
INTERNAL MEDICINE
PALLIATIVE
MEDICINE
INTERNAL MEDICINE
WACO
CARTHAGE
AUSTIN
UPLAND
LIBERTY
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
PA
TX
ROUND ROCK TX
TX
TX
TX
TX
HI
HI
HI
INTERNAL MEDICINE
FORT PIERCE FL
INTERNAL MEDICINE
INTERNAL MEDICINE ADDISON
INTERNAL MEDICINE
INTERNAL MEDICINE
Page 121 of 301
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status Date
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
6/4/2010 None
9/19/2012 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
7/20/2010 None
2/3/2012 None
5/6/2013 None
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/18/2012 None
6/11/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
8/5/2013
7/21/2011
10/11/2011
4/8/2013
9/9/2013
8/20/2013
2/5/2013
Disciplinary
Status of
Texas
License
8/1/2011
12/21/2012
12/21/2012
12/21/2012
None
None
None
None
N/A
N/A
N/A
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
10/1/2010 None
11/5/2012 None
N/A
N/A
2/13/2013 None
7/27/2010 None
N/A
N/A
2/1/2013 None
10/15/2008 None
N/A
N/A
5/1/2013 None
6/13/2011 None
N/A
N/A
License
Number
N9886
P1661
Physician Name
N2619
P6015
KOSHY, PRASHANT GEORGE, MD
LAKHANI, ASIF WAHID, MD
LASEK-NESSELQUIST, SUZANNE,
MD
LEHMAN, WESTON MARK, MD
P5547
LUKE, MANJU, DO
P1350
P0431
edicaid
edicaid
End Date
Designated)
6/3/2011
12/15/2011 12/15/2016 HOSPITALIST
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
TX
TX
ACTIVE
ACTIVE
6/20/2011 None
2/9/2012 None
N/A
N/A
TX
TX
4/8/2009 None
4/15/2013 None
N/A
N/A
2/8/2013 None
N/A
11/18/2011 None
7/22/2011 None
N/A
N/A
7/20/2011 None
N/A
4/12/2013 None
7/14/2010 None
N/A
N/A
2/5/2010 None
11/20/2012 None
N/A
N/A
3/15/2011 None
N/A
3/15/2013 None
9/30/2008 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
4/26/2010 None
7/14/2010 None
1/9/2012 None
N/A
N/A
N/A
2/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
8/5/2013 None
N/A
3/15/2013 None
4/6/2011 None
N/A
N/A
TEMPLE
2/8/2013
INTERNAL MEDICINE
ACTIVE
ACTIVE
LICENSE
ISSUED
11/4/2011
7/15/2011
INTERNAL MEDICINE BAKERSFIELD CA
INTERNAL MEDICINE PALESTINE
TX
ACTIVE
ACTIVE
P0434
MA, SHING-LU, MD
MAJUMDAR, AYANAVA, MD
MANOUKIAN, GEORGE EDWARD,
MD
7/15/2011
TX
P6219
N6922
MARTINEZ, ADRIANA , MD
MATHEWS, ZEEBA , MD
4/12/2013
7/1/2010
FAMILY MEDICINE
INTERNAL MEDICINE ODESSA
TX
N5246
P4596
MINER, GEORGE R. IV, MD
MIRYALA, SHYAMALA, MD
2/5/2010
10/1/2012
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
N9098
MODI, CHIRAG H, MD
3/15/2011
P5850
N1011
MUSGRAVE, WILLIAM LARKIN, DO
NAN, BICHENG , MD
3/15/2013
8/29/2008
MI
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
N5908
N6945
P1676
NGUYEN, KHANH TUNG, MD
NGUYEN, THOMAS MINH, MD
NISAN, ABIGAIL, MD
P5437
P7524
NYATSANZA, IGNATIUS, MD
OBI-OFODILE, DANIEL
CHINWEUBA, MD
P5858
N9276
2/1/2013
8/1/2013
OLAECHEA, JASOR, MD
OMIDVAR, KAMRAN, MD
3/15/2013
4/1/2011
N3963
ORTEGA, SCOTTY, MD
8/21/2009
P7828
OSBORN, CLINTON ROGER, MD
8/30/2013
Disciplinary
Status Date
TEMPLE
INTERNAL MEDICINE BRYAN
4/3/2009
4/1/2013
4/9/2010
7/1/2010
12/15/2011 12/15/2016 HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
INTERNAL MEDICINE
GERIATRIC
MEDICINE (INTERNAL
MED)
INTERNAL MEDICINE
CRITICAL CARE
MEDICINE (IM)
INTERNAL MEDICINE
INTERNAL MEDICINE
DALLAS
ANN ARBOR
NEW BRITAIN CT
ABILENE
TX
FAMILY PRACTICE
INTERNAL MEDICINE
INTERNAL MEDICINE
LUFKIN
URGENT CARE WEST LAKE
FAMILY PRACTICE
HILLS, TX
Page 122 of 301
TX
ACTIVE
9/2/2009 None
N/A
TX
ACTIVE
9/6/2013 None
N/A
License
Number
P2751
P4900
N2231
P3562
P0465
P7327
Physician Name
PAGAN FERRER, JUAN , MD
PARACHA, FARRAH TASNIM, MD
PARHIZGAR, ALIREZA , MD
PARK, JUNG HYUN, MD
PATEL, AMITKUMAR NATVARLAL,
MD
PATEL, LAJJA JITENDRA, MD
edicaid
edicaid
End Date
Designated)
4/2/2012
11/15/2012 11/15/2017 HOSPITALIST
2/6/2009
6/8/2012
Secondary Specialty
(Self-Designated)
Practice City
SAN ANTONIO
HOUSTON
TX
TX
TX
TX
KY
7/15/2011
7/15/2013
INTERNAL MEDICINE
INTERNAL MEDICINE FRANKFORT
1/15/2013
INTERNAL MEDICINE
P0466
P6243
P0924
PATEL, NAYANKUMAR, MD
PATEL, PARISHRAM
BIPINCHANDRA, MD
PHAM, ANTOINE NGUYEN, DO
PHAM, MARY ELIZABETH , MD
7/15/2011
4/12/2013
9/1/2011
INTERNAL MEDICINE
FAMILY MEDICINE
AMARILLO
P3227
P0277
P4501
P6704
PULLALAREVU, RAGHAVESH, MD
PUNATAR, ANKIT D, MD
RAO, BHASKAR, MD
RASHEED, NIDA, MD
5/15/2012
7/1/2011
9/17/2012
5/15/2013
5/15/2017
7/1/2016
9/17/2017
5/15/2018
INTERNAL MEDICINE PITTSBURGH
FAMILY PRACTICE
N6604
N7167
RAVURI, SUMAN CHANDRA, MD
RIAZ, SOHAIL, MD
6/4/2010
7/15/2010
P5233
P1402
P4707
ROY, ANUKUL RANJAN, MD
SAJJAN, RAJENDRA N, MD
SATANI, DHAVAL D, MD
SCROGGINS, JOHN WILLIAM JR,
MD
1/4/2013
11/4/2011
10/15/2012 10/15/2017 HOSPITALIST
8/2/2010
12/17/2012 12/17/2017 HOSPITALIST
12/17/2012 12/17/2017 HOSPITALIST
12/17/2012 12/17/2017 HOSPITALIST
N6998
N4749
N7492
SHAH, MEHA, MD
SHAH, ZAINAB ZAHRA, MD
SHIPCHANDLER, ABEEZAR TAMIM,
MD
SILVA, PAUL M, MD
SINGH, SHANTNU, MD
P0139
SMOCK, DAVID MCCLAIN, MD
P5299
N6988
N7348
P5132
P5132
P5132
7/1/2010
HOSPITALIST
HOSPITALIST
HOSPITALIST
HOSPITALIST
Registration
Status of
Practice
Texas
State
License
TX
TX
PA
TX
TX
INTERNAL MEDICINE
INTERNAL MEDICINE SAN ANGELO TX
INTERNAL MEDICINE BINGHAMTON NY
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
WICHITA
WICHITA
WICHITA
KS
KS
KS
7/1/2010
11/6/2009
8/16/2010
INTERNAL MEDICINE PLANO
TX
TX
6/15/2011
INTERNAL MEDICINE
Page 123 of 301
Registration
Status Date
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
4/3/2012
11/20/2012
3/11/2009
6/28/2012
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Texas
License
UNDER
BOARD
ORDER
None
None
None
Disciplinary
Status Date
3/19/2012
N/A
N/A
N/A
7/15/2011 None
7/16/2013 None
N/A
N/A
1/15/2013 None
N/A
7/15/2011 None
4/25/2013 None
12/9/2011 None
N/A
N/A
N/A
6/4/2012
7/12/2011
10/8/2012
5/20/2013
None
None
None
None
N/A
N/A
N/A
N/A
6/4/2010 None
7/20/2010 None
N/A
N/A
1/4/2013 None
11/18/2011 None
1/9/2013 None
N/A
N/A
N/A
7/1/2010 None
N/A
8/2/2010
12/24/2012
12/24/2012
12/24/2012
None
None
None
None
N/A
N/A
N/A
N/A
7/5/2010 None
1/11/2010 None
8/19/2010 None
N/A
N/A
N/A
6/15/2011 None
N/A
License
Number
Physician Name
N1154
N9316
N8586
SOE, THET , MD
TEIXEIRA, VIVIAN, MD
THENAPPAN, MAHESH V, MD
N6737
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
CANC NONPAYMENT
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
8/29/2008
4/1/2011
1/18/2011
INTERNAL MEDICINE
UPPUTURI, NEELIMA, MD
6/4/2010
INTERNAL MEDICINE
P2074
VAHDAT, KHASHAYAR KASH, MD
2/1/2012
INTERNAL MEDICINE
N8739
VANGA, SHILPA, MD
2/4/2011
P1426
P2079
VARGAS, ALBERTO , MD
WAHEED, UMAR, MD
11/4/2011
2/1/2012
INTERNAL MEDICINE
INTERNAL MEDICINE RENTON
N8871
2/15/2011
P7047
WALTON, GRACE JOY, MD
WARRAICH, KHAWAR NADEEM,
MD
6/14/2013
INTERNAL MEDICINE WATERLOO
IA
P7869
P1439
WEBB, ANTHONY, MD
YANDRAPU, HARATHI, MD
8/30/2013
11/4/2011
INTERNAL MEDICINE
TX
P0946
AHLUWALIA, MANEESHA , MD
9/15/2011
P2412
3/15/2012
N4242
AHMED, YASIR, MD
AKINYEMI, EMMANUEL OLUSESAN,
MD
N9501
ARIZA HEREDIA, ELLA JAZMIN, MD
5/2/2011
N8607
2/4/2011
N7055
ARORA, SUTHEP, MD
BALIGA, CHRISTOPHER SURESH,
MD
7/15/2010
P7244
BARNES, ARTI, MD
7/15/2013
N6179
BHAVAN, KAVITA P, MD
6/4/2010
N6817
BHUSAL, YOGESH , MD
CAHUAYME-ZUNIGA, LIZBETH
JANICE, MD
7/1/2010
P0016
11/6/2009
6/15/2011
INFECTIOUS
9/15/2016 DISEASES
INFECTIOUS
3/15/2017 DISEASES
INFECTIOUS
11/6/2014 DISEASES
INFECTIOUS
5/2/2016 DISEASES
INFECTIOUS
2/4/2016 DISEASES
INFECTIOUS
7/15/2015 DISEASES
INFECTIOUS
7/15/2018 DISEASES
INFECTIOUS
6/4/2015 DISEASES
INFECTIOUS
7/1/2015 DISEASES
INFECTIOUS
6/15/2016 DISEASES
KYLE
ODESSA
WA
Disciplinary
Status Date
12/2/2009 None
4/18/2011 None
1/24/2011 None
N/A
N/A
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
2/20/2012 None
N/A
2/4/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
11/15/2011 None
2/27/2012 None
N/A
N/A
2/15/2011 None
N/A
7/9/2013 None
N/A
8/30/2013 None
11/10/2011 None
N/A
N/A
12/14/2011 None
N/A
3/16/2012 None
N/A
11/13/2009 None
N/A
5/2/2011 None
N/A
2/4/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
DELINQUEN
T-NON
PAYMENT
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
7/23/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
7/23/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/12/2010 None
N/A
6/15/2011 None
N/A
INTERNAL MEDICINE
Page 124 of 301
TX
License
Number
N2427
P5940
P6354
Physician Name
CAIRO LAVADO, JAVIER BENITO,
MD
CAMPO MALDONADO, JOSE
ERNESTO, MD
N3002
CHEN, TING-YI, MD
DAILEY GARNES, NATALIE JANINE
MIRIAM, MD
DE MARCO, BRENDAN MICHAEL,
MD
P1754
FLORES, JOSE, MD
P6399
GOLUB, VITALY, MD
P7115
GUPTA, SUNITA NARENDRA, MD
P1463
JAIJAKUL, SIRAYA , MD
P6661
KHAN, ZARTASH ZAFAR, MD
N5781
P4474
KITCHELL, ELLEN ELIZABETH, MD
KIZILBASH, QURATULAIN FATIMA,
MD
N7295
KOLLI, RADHIKA, MD
P1344
LANDRUM, MICHAEL L, MD
N9888
LAROSA, STEVEN PHILIP, MD
P0846
LEE, FRANCESCA M, MD
P1101
MARFATIA, RINA SUDHIR, MD
P2731
MCGHIE, TRAVEA ALEE, MD
N2660
METZGER, BRIAN SCOTT , MD
MORILLA HOLGUIN, MIGUEL
EMILIO, MD
P4640
P1790
edicaid
edicaid
End Date
Designated)
INFECTIOUS
4/3/2009
4/3/2014 DISEASES
INFECTIOUS
4/1/2013
4/1/2018 DISEASES
INFECTIOUS
5/1/2013
5/1/2018 DISEASES
INFECTIOUS
10/15/2012 10/15/2017 DISEASES
INFECTIOUS
5/29/2009
5/29/2014 DISEASES
INFECTIOUS
1/2/2012
1/2/2017 DISEASES
INFECTIOUS
5/1/2013
5/1/2018 DISEASES
INFECTIOUS
7/1/2013
7/1/2018 DISEASES
INFECTIOUS
11/15/2011 11/15/2016 DISEASES
INFECTIOUS
5/15/2013
5/15/2018 DISEASES
INFECTIOUS
4/9/2010
4/9/2015 DISEASES
INFECTIOUS
9/17/2012
9/17/2017 DISEASES
INFECTIOUS
8/2/2010
8/2/2015 DISEASES
INFECTIOUS
11/4/2011
11/4/2016 DISEASES
INFECTIOUS
6/3/2011
6/3/2016 DISEASES
INFECTIOUS
8/26/2011
8/26/2016 DISEASES
INFECTIOUS
10/3/2011
10/3/2016 DISEASES
INFECTIOUS
4/2/2012
4/2/2017 DISEASES
INFECTIOUS
4/3/2009
4/3/2014 DISEASES
INFECTIOUS
1/2/2012
1/2/2017 DISEASES
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
TX
INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
4/8/2009 None
N/A
4/1/2013 None
N/A
DALLAS
TX
ACTIVE
5/7/2013 None
N/A
HOUSTON
TX
ACTIVE
10/23/2012 None
N/A
TX
ACTIVE
6/17/2009 None
N/A
INTERNAL MEDICINE
ACTIVE
1/10/2012 None
N/A
ACTIVE
5/28/2013 None
N/A
INTERNAL MEDICINE
ACTIVE
7/2/2013 None
N/A
INTERNAL MED PEDS
TX
ACTIVE
11/17/2011 None
N/A
INTERNAL MEDICINE WICHITA
KS
ACTIVE
6/20/2013 None
N/A
TX
ACTIVE
4/20/2010 None
N/A
TX
ACTIVE
10/8/2012 None
N/A
INTERNAL MEDICINE DESOTO
TX
ACTIVE
8/12/2010 None
N/A
ACTIVE
11/10/2011 None
N/A
TX
ACTIVE
6/10/2011 None
N/A
PATHOLOGY
TX
ACTIVE
9/2/2011 None
N/A
TX
ACTIVE
11/15/2011 None
N/A
ACTIVE
4/17/2012 None
N/A
TX
ACTIVE
4/9/2009 None
N/A
TX
ACTIVE
1/9/2012 None
N/A
DALLAS
DALLAS
INTERNAL MEDICINE
Page 125 of 301
PALMVIEW
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
PEREZ POVIS, LORENA DEL
INFECTIOUS
N8335
MILAGRO, MD
12/15/2010 12/15/2015 DISEASES
INFECTIOUS
P2341
PIERI, RICHARD EMEKA, MD
3/1/2012
3/1/2017 DISEASES
INFECTIOUS
P0658
RAMAN, SIVAKUMAR, MD
8/1/2011
8/1/2016 DISEASES
INFECTIOUS
P3569
RAMIREDDY, SWEEYA REDDY , MD
6/8/2012
6/8/2017 DISEASES
RAVAL, BRIJESH ARVINDKUMAR,
INFECTIOUS
N6603
MD
6/4/2010
6/4/2015 DISEASES
INFECTIOUS
P3574
ROIG ROJAS, INGRID LIDIA, MD
6/8/2012
6/8/2017 DISEASES
INFECTIOUS
N1877
SANCHEZ, FERNANDO LUIS, MD
12/12/2008 12/12/2013 DISEASES
INFECTIOUS
P3437
SANCHEZ, KATHRYN TINIO, MD
6/1/2012
6/1/2017 DISEASES
INFECTIOUS
P4819
SERIBURI, VIMON, MD
11/1/2012
11/1/2017 DISEASES
INFECTIOUS
N8458
SHILOH, MICHAEL, MD
1/3/2011
1/3/2016 DISEASES
SUBRAMANIAN,
INFECTIOUS
N2436
OBULAKSHMIPRIYA, MD
4/3/2009
4/3/2014 DISEASES
INFECTIOUS
P2382
TEMPLE, BRIAN A W, MD
3/1/2012
3/1/2017 DISEASES
INFECTIOUS
P0934
THET, ZEYAR , MD
9/1/2011
9/1/2016 DISEASES
INFECTIOUS
P4522
UPPAL, PRIYANKA, MD
9/17/2012
9/17/2017 DISEASES
INFECTIOUS
N4188
WADA, TAKAAKI , MD
8/21/2009
8/21/2014 DISEASES
INTERNAL MED P2845
CULLINAN, PATRICK COREY, DO
4/13/2012
4/13/2017 EMERGENCY MED
ONYENEKWU, NKEIRUKA NGOZI,
INTERNAL MED P3403
MD
6/1/2012
INTERNAL MED N6612
REZAIE, SALIM R, MD
6/4/2010
N1507
ABALIHI, CAROL NGOZI, MD
P5344
CHANG, RHODA YUEH, MD
Secondary Specialty
(Self-Designated)
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
INTERNAL MEDICINE PHILADELPHIA PA
ACTIVE
1/18/2011 None
N/A
INTERNAL MEDICINE
ACTIVE
3/26/2012 None
N/A
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
8/12/2011 None
N/A
6/8/2012 None
N/A
6/4/2010 None
N/A
6/8/2012 None
N/A
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE HUNTSVILLE
AL
INTERNAL MEDICINE LAREDO
TX
JEFFFERSONV
INTERNAL MEDICINE ILLE
IN
ACTIVE
3/2/2009 None
N/A
ACTIVE
6/8/2012 None
N/A
INTERNAL MEDICINE
ACTIVE
12/28/2012 None
N/A
TX
ACTIVE
1/31/2011 None
N/A
DALLAS
TX
ACTIVE
5/8/2009 None
N/A
TX
ACTIVE
3/28/2012 None
N/A
INTERNAL MEDICINE BROOKLYN
NY
ACTIVE
9/7/2011 None
N/A
INTERNAL MEDICINE
ACTIVE
9/27/2012 None
N/A
INTERNAL MEDICINE ABILENE
TX
CRITICAL CARE
MEDICINE
WASHINGTON DC
EMERGENCY
MEDICINE
SAN ANTONIO TX
ACTIVE
9/22/2009 None
N/A
ACTIVE
4/23/2012 None
N/A
ACTIVE
LICENSE
ISSUED
6/11/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
12/22/2008 None
N/A
ACTIVE
2/4/2013 None
N/A
12/12/2008 12/12/2013 INTERNAL MED - PEDS
2/1/2013
Practice City
Registration
Status of
Practice
Texas
State
License
2/1/2018 INTERNAL MED - PEDS
Page 126 of 301
EL PASO
TX
License
Number
edicaid
edicaid
End Date
Designated)
N2034
CHUNG, STEPHANIE THERESE, MD
2/6/2009
Secondary Specialty
(Self-Designated)
PEDIATRIC
2/6/2014 INTERNAL MED - PEDS ENDOCRINOLOGY
P6363
5/1/2013
5/1/2013
N4403
COVINGTON, BILL RAY, MD
COVINGTON, JACQUELYN ROSE,
MD
EVANGELISTA, MONALIZA
SANTOS, MD
11/6/2009
N5052
FILSOOF, DAVID MANSOUR, MD
2/5/2010
N8786
FREMION, ELLEN JEAN, MD
2/15/2011
P2250
GOWANI, JEHANGIR WAZIRALI, MD
P1549
GUNN, ELAINE E, MD
12/1/2011
N0864
8/29/2008
4/1/2013
N3916
JERMYN, RITA ANNE, MD
LAVEDAN, ANNA LIZA CAMUNGOL,
MD
MULUKUTLA, VENKATACHALAM ,
MD
8/21/2009
N6528
NEIL, GIANNI Y, MD
6/4/2010
5/2/2011
HEMATOLOGY 5/2/2016 INTERNAL MED - PEDS INTERNAL MEDICINE DALLAS
P6364
P6014
Physician Name
3/1/2012
3/1/2017 INTERNAL MED - PEDS SLEEP MEDICINE
N9614
NERO, ALECIA, MD
N3945
NGUYEN, HUY QUOC, MD
8/21/2009
N3210
NGUYEN, SUN , MD
5/29/2009
N8049
NIETO, KIRSTEN GIBBS, MD
N4632
OARIS, AKEELA , MD
N9279
N1075
PIERRE, ZENITHE C, MD
PRABHAKAR, BALAKRISHNA
RAJARAM, MD
P1811
RICARD, BRANDY C, MD
Practice City
GALVESTON
COLLEGE
STATION
COLLEGE
STATION
Registration
Status of
Practice
Texas
State
License
4/1/2011
8/29/2008
1/2/2012
Page 127 of 301
Disciplinary
Status Date
TX
ACTIVE
2/19/2009 None
N/A
TX
ACTIVE
5/10/2013 None
N/A
TX
ACTIVE
5/10/2013 None
N/A
12/28/2009 None
N/A
2/5/2010 None
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
DUNCAN
OK
ACTIVE
3/5/2012 None
N/A
BRYAN
TX
ACTIVE
12/5/2011 None
N/A
ACTIVE
9/26/2008 None
N/A
4/5/2013 None
N/A
8/31/2009 None
N/A
6/4/2010 None
N/A
OMAHA
NE
ACTIVE
FT. WORTH
TX
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
6/6/2011 None
N/A
DALLAS
TX
ACTIVE
8/26/2009 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
8/26/2009 None
N/A
10/29/2010 None
N/A
ACTIVE
11/18/2009 None
N/A
10/29/2010 10/29/2015 INTERNAL MED - PEDS
11/6/2009
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
ACTIVE
4/11/2011 None
N/A
SEALY
TX
ACTIVE
9/23/2008 None
N/A
PALESTINE
TX
ACTIVE
1/4/2012 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
N9404
ROSILLO, PATRICIA LIZETTE, MD
4/8/2011
4/8/2016 INTERNAL MED - PEDS RHEUMATOLOGY
N9405
4/8/2011
P2369
RUEDA, JAIME JAVIER, MD
SOKUNBI, ABIMBOLA OLAYINKA,
MD
3/1/2012
N2336
WARUINGI, WAMBUI , MD
2/6/2009
INTERNAL MED - PREV
7/15/2016 MED
INTERNAL MED - PREV
8/15/2018 MED
INTERNAL MED - PREV
11/6/2014 MED
INTERNAL MED - PREV
6/4/2015 MED
12/12/2013 INTERNAL MEDICINE
P0429
P7668
N4801
N6760
N1505
N4228
P4536
N4873
N3410
N1511
N3415
P6306
N2355
P4730
LIBREROS, JAIRO ANDRES, MD
MATHERS, RACHEL ELIZABETH,
MD
7/15/2011
THRASH, DUSTIN BRECK, MD
WALCOTT, FARZANA LUKMANJI,
MD
AASHISH, ANUNAYA , MD
ABANTO, PEDRO RUBEN , MD
ABBASI, NADIA HAFEEZ, MD
11/6/2009
P2568
ABBATE, ROBERT , DO
ABBOUD, LUCIEN NAJI, MD
ABDULLA, ZAINAB , MD
ABRAHAM, ASHA , DO
ABRAHAM, JENSON, MD
ABRAHAM, REENI ANN, MD
ABRAHAM, SAM S, MD
ACOSTA LARA, MARIA DEL PILAR,
MD
N4232
P5253
8/15/2013
6/4/2010
12/12/2008
11/6/2009
10/1/2012
2/5/2010
8/21/2009
12/12/2008 12/12/2013 INTERNAL MEDICINE
8/21/2009
5/1/2013
4/3/2009
11/1/2012
Practice City
HOUSTON
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
TX
ADMINISTRATIVE
MEDICINE
TEXAS CITY
TX
INTERNAL MEDICINE
4/14/2011 None
N/A
ACTIVE
4/14/2011 None
N/A
ACTIVE
3/6/2012 None
N/A
ACTIVE
12/16/2009 None
N/A
ACTIVE
7/20/2011 None
N/A
ACTIVE
8/21/2013 None
N/A
11/18/2009 None
N/A
6/4/2010
12/30/2008
11/27/2009
10/25/2012
None
None
None
None
N/A
N/A
N/A
N/A
2/5/2010
9/1/2009
1/28/2009
8/28/2009
5/8/2013
4/21/2009
11/5/2012
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
4/4/2012 None
N/A
1/20/2010 None
N/A
1/15/2013 None
N/A
2/4/2013 None
N/A
8/23/2010 None
5/27/2011 None
N/A
N/A
2/15/2011 None
N/A
BURLESON
TX
GALVESTON
TX
ACTIVE
NEPHROLOGY
BAY CITY
TX
ACTIVE
LICENSE
ISSUED
POPLAR
BLUFF
GAINESVILLE
TX
HOUSTON
TX
CARDIOLOGY
AUSTIN
TX
FORT WORTH TX
DALLAS
TX
4/2/2012
ADENIYI, MUNIRU OLAKUNLE , MD
11/6/2009
1/15/2013
P5152
ADEYEFA, BABATUNDE , MD
ADEYEKUN, OMOBOLANLE
OMOLAYO, MD
1/4/2013
HOSPITALIST
N7197
N9668
ADGEH, CHERINET SIRAW, MD
ADJOVU, ADELAIDE ADEDE, MD
8/2/2010
5/16/2011
NEPHROLOGY
N8750
AGARWAL, ANAGHA PATIL, MD
2/15/2011
Page 128 of 301
MO
SHREVEPORT LA
HOUSTON
TX
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
N9669
N9155
AGARWAL, NIKHIL, MD
AGARWAL, SUNEAL KUMAR, MD
5/16/2011
4/1/2011
N9994
AHMAD, AFTAB, MD
6/15/2011
HOSPITALIST
N6134
P0947
P0331
AHMAD, HAMEED, MD
AHMAD, SALMAN, MD
AHMAD, TANVIR, MD
6/4/2010
9/15/2011
7/15/2011
HOSPITALIST
P1509
AHMED, ASHRAF, MD
12/1/2011
N5525
N0597
AHMED, FAROOQUE, MD
AHMED, SHAMOON, MD
4/9/2010
8/29/2008
P5319
N9156
N9996
AHMED, SOHAIL, MD
AHN, DANIEL , DO
AILNANI, SUPRIYA, MD
2/1/2013
4/1/2011
6/15/2011
P1723
AJIBADE, TOPE, MD
1/2/2012
P6763
AJMAL, MUHAMMAD SULEMAN, MD
AJUMOBI, ADEWALE BABATUNDE,
MD
AKANDE, LATIFA O, DO
AKHTER, JAWEED, MD
AKTUNC, ERDEM, MD
6/3/2013
P1511
N9498
P6312
P7376
P0160
P5768
P2570
ALALAWI, RAED , MD
ALATTAR, MONA LISA , MD
ALAWI-KAKOMANOLIS, NADIA
ANNE, MD
P7377
P3603
ALBURKI, ABDUSSALAM M, MD
ALDEIRI, MOLHAM , MD
P5504
ALEXANDER, NEBU T, MD
ALFARAWATI, MOHAMMAD
NABEEL, MD
P1724
12/1/2011
5/2/2011
5/1/2013
8/1/2013
12/1/2016
5/2/2016
5/1/2018
8/1/2018
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
7/1/2011
3/15/2013
4/2/2012
8/1/2013
6/15/2012
2/8/2013
1/2/2012
EMERGENCY
MEDICINE
Practice City
LOVELAND
YAKIMA
EL PASO
HOUSTON
AUSTIN
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
OH
ACTIVE
WA
ACTIVE
LICENSE
ISSUED
TX
TX
TX
GASTROENTEROLOG
Y
SAN ANTONIO TX
DIABETES
HOSPITALIST
PULMONARY
CRITICAL CARE
MEDICINE
ONCOLOGY
INFECTIOUS
DISEASES
INFECTIOUS
DISEASES
PULMONARY
DISEASES
Page 129 of 301
KARACHI
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/16/2011 None
4/6/2011 None
N/A
N/A
6/15/2011 None
N/A
6/4/2010 None
10/3/2011 None
8/31/2011 None
N/A
N/A
N/A
12/1/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/16/2010 None
9/5/2008 None
N/A
N/A
2/1/2013 None
4/20/2011 None
6/20/2011 None
N/A
N/A
N/A
1/2/2012 None
N/A
6/3/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
2/23/2012
6/1/2011
7/3/2013
8/6/2013
None
None
None
None
N/A
N/A
N/A
N/A
LUBBOCK
DALLAS
TX
TX
ACTIVE
ACTIVE
7/6/2011 None
4/1/2013 None
N/A
N/A
BROOKLYN
NY
ACTIVE
4/5/2012 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
8/6/2013 None
6/18/2012 None
N/A
N/A
DESOTO
TX
ACTIVE
2/12/2013 None
N/A
ACTIVE
1/9/2012 None
N/A
Physician Name
edicaid
edicaid
End Date
Designated)
N9157
N1524
AL-HAFNAWI, MOTAZ KHALED, MD
ALHAZIM, DINA, MD
4/1/2011
N6126
P5322
AL-HINDI, AHMAD, MD
ALI, ADIL RUKNUDDIN, MD
6/4/2010
2/1/2013
N6137
ALI, BAKHTIAR , MD
6/4/2010
License
Number
P4923
ALI, SAYED KARAR, MD
P2822
ALI, SYED MUJTABA, MD
ALOBAIDI, AHMED MOHAMMED
KHAIRI, MD
P6320
N6141
4/13/2012
5/1/2013
6/4/2010
N3430
N9672
ALOZIE, OGECHIKA KARL, MD
AL-RAJABI, RAED MOH'D TAISEER ,
MD
AL-SAADI, MUKHTAR A, MD
8/21/2009
5/16/2011
P0534
N2916
N3439
ALSHAREEF, BASHAR NIMAN, MD
ALVES, PATRICE , MD
ALVES, TAHIRA PALMER , MD
8/1/2011
5/29/2009
8/21/2009
N4902
ALY, SALMAN SIRAJ, MD
2/5/2010
N4903
N8267
N7208
ALY, SARFRAZ, MD
AMADOR, MELISSA , MD
AMAYA CHINCHILLA, HECTOR
GERARDO, MD
AMIN, NIRAV, DO
ANAMEKWE, KENECHIM
ANYANWU, MD
N3445
N8604
N0605
P5584
P0696
2/5/2010
8/29/2008
3/1/2013
8/2/2010
ANAYA, CANDIDO JAVIER, MD
8/21/2009
ANCAYA, DORA VICTORIA, MD
ANNAPUREDDY, CHANDRA
SEKHAR REDDY, MD
2/4/2011
8/15/2011
Secondary Specialty
(Self-Designated)
HEPATOLOGY
Practice City
MIAMI
DALLAS
Registration
Status of
Practice
Texas
State
License
FL
TX
CARDIOLOGY
PALLIATIVE
MEDICINE
NEPHROLOGY
DALLAS
TX
INFECTIOUS
DISEASES
OTHER SPECIALTY
SAN ANTONIO TX
HOUSTON
TX
NEPHROLOGY
SAN ANTONIO TX
SAN ANTONIO TX
INFECTIOUS
DISEASES
N/A
N/A
6/4/2010 None
2/6/2013 None
N/A
N/A
6/4/2010 None
N/A
11/30/2012 None
N/A
4/13/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/7/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/9/2009 None
5/20/2011 None
N/A
N/A
8/1/2011 None
6/30/2009 None
9/25/2009 None
N/A
N/A
N/A
2/5/2010 None
N/A
2/5/2010 None
1/14/2011 None
N/A
N/A
9/5/2008 None
4/3/2013 None
N/A
N/A
9/27/2010 None
N/A
11/19/2009 None
N/A
2/4/2011 None
N/A
8/25/2011 None
N/A
TX
HARLINGEN
TX
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
SAN ANTONIO TX
Disciplinary
Status Date
4/12/2011 None
1/5/2009 None
HOUSTON
HOSPITALIST
Page 130 of 301
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
License
Number
Physician Name
P3278
ANSARI, SHAN NUR, MD
P5770
P5325
ANWAR, MUHAMMAD SALEEM, MD
ARAPOS, LEONIDAS, MD
N1532
ARAZI, TEOFILO JUAN CARLOS,
MD
P7061
ARGISHTI, NARINE, MD
P1517
ARIAS, ROBERT RANET, MD
N4917
ARMSTRONG, FELICIA ANN, MD
P4542
edicaid
edicaid
End Date
Designated)
6/1/2012
3/15/2013
2/1/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
HOSPITALIST
HOSPITALIST
DALLAS
TX
7/1/2013
12/1/2011
2/5/2010
10/1/2012
P6130
N4262
P0165
N7772
N2386
P1518
ARROYO-AVILA, MARIANGELI , MD
ARVAPALLI, BHAGYALAKSHMI V,
MD
ARYA, BASANT, MD
ASHARAF, ABDULRASHEED, MD
ASHBY, KEITH MEREDITH, MD
ASHRAF, SYED SAUD, MD
ASLAM, MURAD , MD
4/12/2013
11/6/2009
7/1/2011
10/1/2010
4/3/2009
12/1/2011
4/12/2018
11/6/2014
7/1/2016
10/1/2015
4/3/2014
12/1/2016
P4543
ATLURI, SAI, MD
10/1/2012
N4924
N2391
N4267
P2190
ATLURI, SUMITHA , MD
AZIZ, ASIF , MD
AZIZ, FATIMA , MD
AZIZ, WESAM SABRI, MD
2/5/2010
4/3/2009
11/6/2009
3/1/2012
2/5/2015
4/3/2014
11/6/2014
3/1/2017
N9805
6/3/2011
P5591
N0620
BABINEAUX, MICHAEL JAMES, MD
BADIDI, OGHENETEGA ABRAHAM,
MD
BADLISSI, JOHN KERRY, MD
P3115
BADLISSI, MICHAEL, MD
N5545
P5157
BAHADORANI, JOHN NADER, MD
BAKAJ, GENTIANA, MD
SULPHUR
SPRINGS
PORT
ARTHUR
ACTIVE
ACTIVE
DELINQUEN
T-NON
PAYMENT
2/5/2010 None
N/A
10/4/2012 None
N/A
SAN JOSE
CA
CHARLESTON WV
HARLINGEN
TX
GALVESTON
TX
3/1/2013
8/29/2008
DALLAS
NEDERLAND
TX
TX
5/15/2012
GERIATRICS INTERNAL MEDICINE
4/9/2015 INTERNAL MEDICINE CARDIOLOGY
Page 131 of 301
GREENVILLE
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
4/9/2010
1/4/2013
8/6/2013 None
12/2/2011 None
TX
FL
TX
WV
TX
HOSPITALIST
HOSPITALIST
N/A
ACTIVE
LICENSE
ISSUED
HOUSTON
BARTOW
HUMBLE
CHARLESTON
AUSTIN
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
3/12/2009 None
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HOSPITALIST
N/A
N/A
ACTIVE
TX
CARDIOLOGY
HOSPITALIST
4/26/2013 None
2/15/2013 None
TX
DALLAS
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
UNDER
BOARD
6/13/2012 ORDER
5/10/2012
NC
4/12/2013
11/11/2009
7/6/2011
10/19/2010
9/22/2009
12/7/2011
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
10/30/2012 None
N/A
2/5/2010
5/18/2009
12/17/2009
3/6/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
6/10/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
4/3/2013 None
9/11/2008 None
N/A
N/A
5/15/2012 None
N/A
4/9/2010 None
2/7/2013 None
N/A
N/A
License
Number
Physician Name
P7064
BAKSHI, PRATIMA RAMESH, MD
P6582
N6811
edicaid
edicaid
End Date
Designated)
7/1/2013
P1446
N8272
N4279
P6333
N7056
P0698
N9350
N3478
BALLAPURAM, KALYANI, MD
BALLARD, AMY MICHELLE, DO
BALMER-SWAIN, MALLORY ANNE,
DO
BANDARU, HIMABINDU, MD
BANERJEE, KAKOLI, MD
BANSAL, ARVIN, MD
BAPAT, VIJAY , MD
BARE, SUDHIR, MD
BARKER, BLAKE R, MD
BARKER, EMILY CHISM, MD
5/15/2013
7/1/2010
N7392
BARRERA, ALEJANDRO DAVID, MD
8/16/2010
P5259
BARRETTO, JOHAN JUDE, MD
1/15/2013
N7776
BARTOSH, NICOLE SCHROCK, DO
10/1/2010
P5776
BASANI, SAMATA, MD
3/15/2013
11/6/2009
5/1/2013
7/15/2010
8/15/2011
4/8/2011
8/21/2009
BASHIR, QAISER , MD
BASSETT, SCOTT TAYLOR, MD
BASSEY, UKANA, DO
BATCHU, VISHALAKSHMI , MD
4/3/2009
12/1/2010
2/8/2013
8/21/2009
4/3/2014
12/1/2015
2/8/2018
8/21/2014
N7522
N7393
BAYRAKTAR, SOLEY , MD
BEGUM, MAHMUDA , MD
8/27/2010
8/16/2010
N6168
BEITINJANEH, AMER, MD
6/4/2010
P1850
P4547
P7247
BEKANICH, STEPHEN JAMES, MD
BENFOLD, NICOLE , MD
BENJAMIN, BIJAS , MD
BENTON, CHRISTOPHER BRENT,
MD
1/17/2012
10/1/2012
7/15/2013
4/9/2010
P5512
BENTON, MARIA FLORENCIA, MD
2/8/2013
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
Practice City
WICHITA
FALLS
N2397
N8166
P5509
N3486
N5566
Secondary Specialty
(Self-Designated)
INTERNAL MEDICINE PHILADELPHIA
FORTWORTH
AUSTIN
HOUSTON
DALLAS
CHICAGO
HOUSOTN
HARLINGEN
TEMPLE
Registration
Status of
Practice
Texas
State
License
ACTIVE
TX
ACTIVE
ACTIVE
PA
TX
TX
TX
TX
TX
IL
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TX
TX
HEMATOLOGY/ONCO
LOGY
HOUSTON
TX
FORT WORTH TX
HOUSTON
TX
HEMATOLOGY/ONCO
LOGY
HOUSTON
CEDAR PARK
HEMATOLOGY/ONCO
LOGY
PALLIATIVE
MEDICINE
MIAMI
DALLAS
HEMATOLOGY/ONCO
LOGY
HOUSTON
Page 132 of 301
TX
TX
FL
TX
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/9/2013 None
N/A
5/23/2013 None
7/12/2010 None
None
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
8/19/2010 None
N/A
1/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
10/11/2010 None
N/A
3/15/2013 None
N/A
4/8/2009
12/6/2010
2/18/2013
9/4/2009
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
11/22/2011
12/31/2010
1/11/2010
5/10/2013
7/19/2010
8/18/2011
4/21/2011
8/27/2009
N/A
N/A
None
None
None
None
SEE
PREVIOUS
9/9/2010 ORDER
8/31/2010 None
8/30/2010
N/A
6/4/2010 None
N/A
1/20/2012 None
10/22/2012 None
7/17/2013 None
N/A
N/A
N/A
4/9/2010 None
N/A
2/12/2013 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N7221
BERZOSA CORELLA, MANUEL , MD
P1964
N3497
BEST, AARON PATRICK, MD
BETANCO, JORGE ANTONIO, MD
P5035
BEYENE, TESFAYE KEBEDE, MD
P5035
P5035
P6143
BHADRIRAJU, SATISH, MD
BHAKTHAVATSALAM,
HEMAVATHY, MD
4/12/2013
N5572
8/2/2010
2/1/2012
8/21/2009
4/9/2010
Secondary Specialty
(Self-Designated)
Practice City
GASTROENTEROLOG
Y
HOUSTON
SLEEP MEDICINE
P2196
BHATTI, MAQSOOD AHMED, MD
3/1/2012
P0007
BHIMARAJ, ARVIND, MD
BHOOPAL, JAIDEV RAGHURAM,
MD
BHUTTA, SIDRA M, MD
6/15/2011
8/29/2008
8/1/2013
HOSPITALIST
HOSPITALIST
4/15/2011
8/29/2008
5/1/2012
1/15/2013
4/15/2016
8/29/2013
5/1/2017
1/15/2018
INTERNAL MEDICINE
N3507
BIBOA, JOHN CLEMENT, DO
BILKIS, SAYEEDA , MD
BILLATOS, EHAB , MD
BISEN, AJIT KUMAR, MD
BLUM MARIDUENA, MARIELA
ANABEL, MD
8/21/2009
N8766
BOE, RUTH , MD
2/15/2011
N8378
BOGOSSIAN, DEBRA ANNE, MD
1/3/2011
N9434
N0651
P2958
P5260
N8275
BOLANOS, KARLA PATRICIA, MD
N2410
N4304
BOLLINENI, SRINIVAS , MD
BOLZ, ANGELA DENE', DO
BONNET, DAVID MACNAUGHTAN,
MD
N7992
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
4/3/2009
11/6/2009
TX
SAN ANTONIO TX
INFECTIOUS
DISEASES
CARDIOVASCULAR
DISEASES
N0648
P7394
Registration
Status of
Practice
Texas
State
License
HOSPITALIST
HEMATOLOGY/ONCO
LOGY
Disciplinary
Status Date
8/23/2010 None
N/A
2/1/2012 None
9/1/2009 None
N/A
N/A
12/17/2012 None
N/A
NEWPORT
AR
ACTIVE
1/14/2013 None
N/A
NEWPORT
NEWNAN
AR
GA
ACTIVE
ACTIVE
1/14/2013 None
4/26/2013 None
N/A
N/A
HENDERSON
NC
ACTIVE
4/26/2010 None
N/A
HOQUIAM
WA
ACTIVE
3/12/2012 None
N/A
ACTIVE
6/20/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
9/17/2008 None
8/16/2013 None
N/A
N/A
4/15/2011
9/10/2008
5/3/2012
1/22/2013
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/28/2009 None
N/A
2/15/2011 None
N/A
1/3/2011 None
N/A
TX
ACTIVE
2/11/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
4/8/2009 None
11/24/2009 None
N/A
N/A
10/29/2010 None
N/A
HOUSTON
TX
NACOGDOCH
ES
TX
PECOS
DALLAS
LEBANON
GERIATRIC
MEDICINE (INTERNAL
MED)
TEMPLE
PULMONARY
CRITICAL CARE
MEDICINE
HOUSTON
PARIS
Page 133 of 301
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
PA
License
Number
N7607
N7226
Physician Name
BOQUE-SANTIAGO, MIGUEL JUAN,
MD
BOSE, SUBHASH, MD
N4956
edicaid
edicaid
End Date
Designated)
9/1/2010
8/2/2010
BOUYARDEN, MICHAEL, MD
2/5/2010
N4958
BRAZA, MARIEJANE MALINAO, MD
2/5/2010
N9436
N7061
BRINKER, STEPHANIE KAYE, MD
BUI, BAO QUOC, MD
4/15/2011
7/15/2010
N6199
BURGOS, JOSE DAVID, MD
6/4/2010
N2017
BURRI, MANJULA VANI, MD
2/6/2009
N3527
P2602
P7403
P0354
N5601
N7784
P0706
N3536
P5250
N7236
BUTT, SANOBER, MD
CACERES LARA, ALFREDO BORIS,
MD
CAGA-ANAN, MARIA CRISTINA
ESPERA, MD
CALDERON, ANA MARIA, MD
CALLEY, DOYLE, MD
CAMCIOGLU, BELGIN, MD
CANOVA CIPRIANO, EDUARDO
CARLOS, MD
CAPT, WILLIAM MICHAEL, MD
8/21/2009
4/2/2012
CARABELLO, BLASE ANTHONY, MD
CARDENAS GOMEZ, EDGAR IVAN,
MD
8/1/2013
7/15/2011
4/9/2010
10/1/2010
8/1/2018
7/15/2016
4/9/2015
10/1/2015
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
8/15/2011
8/21/2009
1/4/2013
8/2/2010
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
BALTIMORE
NEPHROLOGY
AMARILLO
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
MD
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
PULMONARY
CRITICAL CARE
MEDICINE
HOSPITALIST
SAN ANTONIO TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/1/2010 None
8/23/2010 None
N/A
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
4/15/2011 None
7/22/2010 None
N/A
N/A
6/4/2010 None
N/A
5/7/2009 None
N/A
ACTIVE
12/30/2009 None
N/A
ACTIVE
4/6/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
8/12/2013
8/24/2011
4/27/2010
10/25/2010
None
None
None
None
N/A
N/A
N/A
N/A
FREMONT
MI
RADIOLOGY
LAREDO
LUBBOCK
TX
TX
ACTIVE
ACTIVE
8/18/2011 None
10/8/2009 None
N/A
N/A
CARDIOLOGY
HOUSTON
TX
ACTIVE
1/16/2013 None
N/A
MONAHANS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
9/3/2010 None
N/A
PALLIATIVE
MEDICINE
N4975
P3127
P3516
P2606
P3298
CARRASCO, ERIK, MD
CARRERO, ANGELA MARIA, MD
CARROTHERS, IRENE A, MD
CARROUTH, DAVID AARON, MD
CARUSO, ANDREW C, MD
2/5/2010
5/15/2012
6/8/2012
4/2/2012
6/1/2012
2/5/2015
5/15/2017
6/8/2017
4/2/2017
6/1/2017
N8624
P2836
CARUSO, LOUIS, MD
CASTILLO, JUANITA, MD
2/4/2011
4/13/2012
Page 134 of 301
HOSPITALIST
DALLAS
ADDISON
HOUSTON
TX
TX
TX
2/5/2010
6/14/2012
6/19/2012
4/4/2012
6/14/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
2/4/2011 None
4/18/2012 None
N/A
N/A
License
Number
Physician Name
N2980
CASTILLO, LETICIA, MD
CEBALLOS, GILDARDO ANDRES,
P0357
MD
P6955
CEPEDA-IRUEGAS, NIRU , MD
N7065
CEVIK, CIHAN, MD
P5943
CHALLA, TEJO RAMAM, MD
edicaid
edicaid
End Date
Designated)
5/29/2009
7/15/2011
6/14/2013
7/15/2010
4/1/2013
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
N2435
CHANDER, AJAY , MD
N1278
CHANDRAVANKA, CHAITANYA
SRAVANTHI, MD
P5051
P5051
P5051
CHAUDHARY, VISHY, MD
N9439
N0692
N7067
P1977
CHAUDHRY, SAMEER, MD
CHAUVET, MARCELO, MD
CHAVAN, SUMEET NARESH, MD
CHAVDA, CHIRAG, MD
N9527
CHEEMA, YASIR IMTIAZ, MD
5/2/2011
N6219
CHEN, NANCY , MD
6/4/2010
P2214
P6598
P1627
P4555
P1062
CHEUNG, MIN-YUEN CYNTHIA, MD
CHILUVERI, MADHU, MD
CHING, LINA MIRIAM, MD
CHIRACHANCHAI, MIKE GLA, MD
CHITTURI, RADHA KUMARI, MD
4/3/2009
7/15/2016
6/14/2018
7/15/2015
4/1/2018
4/15/2011
8/29/2008
7/15/2010
2/1/2012
4/15/2016
8/29/2013
7/15/2015
2/1/2017
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
3/1/2012
5/15/2013
10/1/2012
10/3/2011
N7068
N7609
P5349
CHOI, YOU SUK, MD
CHOUEIRI, MICHEL , MD
CHOWDHURY, ASHWINI, MD
7/15/2010
9/1/2010
2/1/2013
P0714
CHRONISTER, JUSTIN DAVID, DO
8/15/2011
P1629
N0702
CHRONISTER, STACY, DO
CHUA, MATT JEREMIAH TAN, MD
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
RICHMOND
TX
CARDIOLOGY
HOUSTON
TX
CARDIOVASCULAR
DISEASES
NORFOLK
NE
YORK
YORK
PA
PA
HOSPITALIST
EL PASO
TX
SAN ANTONIO TX
PULMONARY
MEDICINE
MOUNYAIRY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
HOSPITALIST
RHEUMATOLOGY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
HOSPITALIST
8/29/2008
8/29/2013 INTERNAL MEDICINE HOSPITALIST
Page 135 of 301
LOS ANGELES
LONGVIEW
HOUSTON
ALLEN
GUN BARREL
CITY
HOUSTON
PALESTINE
CORPUS
CHRISTI
CORPUS
CHRISTI
JERSEY CITY
NC
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
6/19/2009 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/20/2011
6/26/2013
7/26/2010
4/15/2013
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
4/14/2009 None
N/A
1/8/2009 None
N/A
12/17/2012 None
1/17/2013 None
1/17/2013 None
N/A
N/A
N/A
4/15/2011
10/15/2008
7/19/2010
2/24/2012
None
None
None
None
N/A
N/A
N/A
N/A
5/11/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
CA
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TX
TX
TX
3/5/2012
5/17/2013
12/19/2011
10/4/2012
10/28/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
7/20/2010 None
9/6/2010 None
2/4/2013 None
N/A
N/A
N/A
TX
ACTIVE
8/22/2011 None
N/A
TX
NJ
ACTIVE
ACTIVE
1/12/2012 None
12/15/2008 None
N/A
N/A
License
Number
Physician Name
N2442
CHUKWU, IKEDIEZE IGWE, MD
CHUKWUNYERE, EMMANUEL
N5628
AMAM, MD
P3304
CHUNDRU, VITTAL KUMAR, MD
N8285
CHUNDURI, ANIL KUMAR, MD
N9359
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
4/3/2009
4/9/2010
6/1/2012
P0565
N9034
CHUNG, YU LIN IRENE, MD
CIRES-DROUET, RAFAEL
SANTIAGO, MD
COGAR, BRYAN DEAN, MD
P3305
N2038
COLLINS, AISHA RENEE, MD
COLQUE, MOLLY JOY, MD
6/1/2012
2/6/2009
N6844
7/1/2010
N7913
CONTRERAS, GAIL EVON, MD
CORCORAN, JACQUELINE ESTEE,
DO
P1983
CORNWELL, WILLIAM KENT III, MD
P1536
CORONA, RITA ESMERALDA, MD
P1984
N1294
N3585
COSS, ELIZABETH , MD
CRUZ CARRERAS, MARIA TERESA,
MD
CUERVO, LUIS JAIME, MD
N6848
DACI, KUANG, MD
N3592
D'AGOSTINO, DARRIN
CHRISTOPHER, DO
P2625
Practice City
HOUSTON
HOSPITALIST
AKRON
4/8/2011
INTERNAL MEDICINE
8/1/2011
3/15/2011
VASCULAR MEDICINE
CARDIOLOGY
HOSPITALIST
PALLIATIVE
MEDICINE
DENVER
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
OH
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
CO
ACTIVE
ACTIVE
LICENSE
ISSUED
2/1/2012
12/1/2011
2/1/2012
CARDIOLOGY
TX
ACTIVE
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
GASTROENTEROLOG
Y
8/21/2009
7/1/2010
DALLAS
HOUSTON
TEMPLE
TX
TX
8/21/2009
DALMACION-LAYNO, GRACE, MD
4/2/2012
N6243
N9360
P7419
DANDAMUDI, SAROJA, MD
DANG, HONG, MD
DANG, NATALIE MYLAN, MD
6/4/2010
4/8/2011
8/1/2013
P0822
DANIEL, HELEN CHARISSE, MD
8/26/2011
NEUROMUSCULOSK
ELETAL
MEDICINE/OMT
FT. WORTH
FAR
ROCKAWAY
4/9/2010 None
6/27/2012 None
12/21/2010 None
N/A
N/A
N/A
4/8/2011 None
N/A
8/1/2011 None
3/31/2011 None
N/A
N/A
6/1/2012 None
2/12/2009 None
N/A
N/A
7/12/2010 None
N/A
10/15/2010 None
N/A
2/6/2012 None
UNDER
BOARD
12/5/2011 ORDER
N/A
11/21/2011
2/1/2012 None
N/A
10/16/2008 None
11/5/2009 None
N/A
N/A
7/1/2010 None
N/A
TX
ACTIVE
8/28/2009 None
N/A
NY
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
4/18/2012 None
N/A
6/4/2010 None
4/14/2011 None
8/8/2013 None
N/A
N/A
N/A
8/26/2011 None
N/A
HOSPITALIST
Page 136 of 301
ACTIVE
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
4/8/2009 None
N/A
HOUSTON
TX
LONGVIEW
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P5526
N4369
N1604
DAO, BAO DUY, MD
DARAMOLA, JOHN, MD
DASARI, VIJAYA MADHAVI, MD
P2224
N1299
DATLA, SIREESHA, MD
DAUD AGUERO, BENJAMIN YEMIZ,
MD
DAVE, KAPIL JAGDISHCHANDRA,
MD
N6248
N8087
P5169
P6155
P0899
DAVILA ARROYO, HIMARA, MD
DAVOUDIAN, VAHEH, MD
DAYANI, ARIA, MD
DE LA MORA, DIEGO , MD
DE LOS SANTOS, BILLY A, MD
6/4/2010
1/4/2013
4/12/2013
9/1/2011
P6805
P0368
DE LOS SANTOS, MARCO
ANTONIO, MD
DEBELA, ZENEBE ASFAW, MD
6/3/2013
7/15/2011
P0369
DEL CRISTO, ROBERTO RAUL, MD
7/15/2011
P1289
P5059
P5059
P5059
DELGADO, GUSTAVO ADOLFO, MD
DELYRIA, PAUL , MD
DELYRIA, PAUL , MD
DELYRIA, PAUL , MD
DEO, SHEETAL RAMACHANDRA,
MD
DEPPISCH, HANNAH GRUBB, MD
DESHPANDE, ALOK , MD
DESTA, DEREJE, MD
N7412
P0572
N3611
P6604
P2635
P0373
P5269
DHAWAN, RICHA, MD
DOMINGUEZ VALLEJOS, LUIS
AUGUSTO, MD
N6262
DOMINGUEZ, MANUEL , MD
N5657
N9042
DONDAPATI, CHANDRA MALINI, DO
DOPKE, CHERYL ANNE, DO
2/8/2013
11/6/2009
3/1/2012
8/16/2010
Secondary Specialty
(Self-Designated)
HOSPITALIST
GREENVILLE
INTERNAL MEDICINE
EMERGENCY
MEDICINE
8/1/2016
8/21/2014
5/15/2018
4/2/2017
7/15/2011
1/15/2013
6/4/2010
4/9/2010
3/15/2011
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/8/2013 None
11/16/2009 None
2/27/2009 None
N/A
N/A
N/A
3/1/2012 None
N/A
9/1/2010 None
N/A
1/19/2009 None
N/A
6/4/2010
12/8/2010
1/11/2013
4/26/2013
9/6/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
AMARILLO
TX
ACTIVE
HOSPITALIST
ANGLETON
TX
HOSPITALIST
CARROLLTON
CLARKSVILLE
DALLAS
MESQUITE
TX
TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
AUSTIN
TX
LICENSE
ISSUED
ACTIVE
6/3/2013 None
7/22/2011 None
N/A
N/A
HEREFORD
TX
ACTIVE
7/22/2011 None
N/A
BRYAN
TX
TEMPLE
HOUSTON
KANSAS
TX
TX
KS
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
PULMONARY
CRITICAL CARE
MEDICINE
11/4/2011
8/1/2011
8/21/2009
5/15/2013
4/2/2012
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SC
ACTIVE
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
RHEUMATOLOGY
SHREVEPORT LA
NEPHROLOGY
4/9/2015 INTERNAL MEDICINE INTERNAL MEDICINE DALLAS
TX
FORT WORTH TX
Page 137 of 301
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
11/10/2011
12/24/2012
12/24/2012
12/24/2012
None
None
None
None
N/A
N/A
N/A
N/A
8/1/2011
10/7/2009
5/27/2013
4/13/2012
None
None
None
None
N/A
N/A
N/A
N/A
8/1/2011 None
N/A
1/15/2013 None
N/A
6/4/2010 None
N/A
4/9/2010 None
4/1/2011 None
N/A
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N8638
N8091
D'SOUZA, SWATI FRANCISCA, MD
DUEWALL, JENNY , MD
2/4/2011
P2111
P0721
N9848
N3624
DUGGIRALA, RAVI KUMAR, MD
DUONG, HUYEN VU, MD
DUVAL, TARA MICHELLE, MD
DWIBHASHI, VIJAYA L , MD
2/10/2012
8/15/2011
6/3/2011
8/21/2009
2/10/2017
8/15/2016
6/3/2016
8/21/2014
N7695
9/15/2010
N7251
P5971
N5664
P3146
P6612
EBUH, VALENTINE MBEPSON, MD
ECHAVEZ-ARROYO, MARIA
SUSANA, MD
EDWARDS, JEFFERY D, MD
EJERE, HENRY OMOIKHUDU, MD
EL AHDAB, SAMIH , MD
ELLENT, LIBBY, MD
8/2/2010
4/1/2013
4/9/2010
5/15/2012
5/15/2013
8/2/2015
4/1/2018
4/9/2015
5/15/2017
5/15/2018
P7105
ELLISON, JEFFREY COWAN, MD
P1297
P6160
P7104
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
7/1/2013
ELMHISHI, OSAMA MOHAMED, MD
ELNEMR, MINA , MD
EL-QADDOUMI, HIBA F, MD
11/4/2011
4/12/2013
7/1/2013
N8910
N3633
ELSAID, SAMEH FOUAD, MD
ELSANJAK, ABDELAZIZ ALI, MD
3/1/2011
8/21/2009
P0046
ELUEZE, IFEANYI EMMANUEL, MD
6/15/2011
N6864
P4947
ENGELKING, LUKE JAMES, MD
ENWEMNWA, NNEAMAKA, MD
P2233
ESCALANTE, THERESA JEAN, MD
3/1/2012
P1994
ESCANDON, JOSE AMBROSIO, MD
ESCOBAR CAMARGO, JORGE
MARIO, MD
2/1/2012
P4863
N0753
P5625
ESTRADA, MANUEL ARTURO, MD
EVERETT, JENNIFER MICHELLE,
DO
Secondary Specialty
(Self-Designated)
Practice City
HOSPITALIST
HOSPITALIST
CLEARWATER
,
FL
DALLAS
HOUSTON
HOSPITALIST
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
DALLAS
ALBANY
TX
TX
TX
GA
GASTROENTEROLOG
Y
Registration
Status Date
Disciplinary
Status of
Texas
License
2/4/2011 None
11/18/2010 None
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
2/20/2012
8/19/2011
6/20/2011
9/21/2009
Disciplinary
Status Date
N/A
N/A
None
None
None
None
N/A
N/A
N/A
N/A
9/15/2010 None
N/A
8/2/2010
4/9/2013
4/26/2010
5/17/2012
5/29/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
7/1/2013 None
N/A
INTERNAL MEDICINE IOWA CITY
HOSPITALIST
HOUSTON
MIDLAND
INFECTIOUS
DISEASES
TROY
HOSPITALIST
DANVILLE
IA
TX
TX
ACTIVE
ACTIVE
ACTIVE
11/8/2011 None
4/22/2013 None
7/3/2013 None
N/A
N/A
N/A
NC
VA
ACTIVE
ACTIVE
3/28/2011 None
9/1/2009 None
N/A
N/A
LONGVIEW
GASTROENTEROLOG
Y
DALLAS
TX
ACTIVE
6/21/2011 None
N/A
TX
ACTIVE
ACTIVE
7/14/2010 None
12/11/2012 None
N/A
N/A
KERRVILLE
TX
ACTIVE
4/10/2012 None
N/A
HARLINGEN
TX
ACTIVE
2/3/2012 None
N/A
HOUSTON
TX
ACTIVE
12/24/2012 None
N/A
ODESSA
TX
ACTIVE
9/30/2008 None
N/A
WOODLANDS TX
ACTIVE
4/22/2013 None
N/A
7/1/2010
8/29/2008
3/1/2013
CARDIOLOGY
Page 138 of 301
License
Number
N0754
P5178
P5063
P5063
P5063
N8782
P3149
P7109
N7920
N3640
P0975
Physician Name
EWALEIFOH, BENEDICT
EROMOSELE, MD
FABELA, PAUL ANDREW, MD
FAHOURY, ALEX IBRAHIM, MD
FALDU, HIRENKUMAR AMRUTLAL,
MD
FARAHAT, ALAA, MD
FARRAG, SAFA ELSEBAI, MD
FARRICIELLI, ELLA VIKTOROVNA,
MD
FATEMI, OMID , MD
FELIZ RODRIGUEZ, NILSON DAVID,
MD
edicaid
edicaid
End Date
Designated)
8/29/2008
1/4/2013
2/15/2011
5/15/2012
7/1/2013
Secondary Specialty
(Self-Designated)
HOSPITALIST
HOSPITALIST
HOSPITALIST
NEPHROLOGY
8/21/2009
Practice City
MCCOMB
DENTON
BROCKPORT
BROCKPORT
BROCKPORT
Registration
Status of
Practice
Texas
State
License
MS
TX
NY
NY
NY
FORT DODGE IA
EL PASO
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
ACTIVE
ABILENE
TX
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LUBBOCK
TX
ACTIVE
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
ACTIVE
Registration
Status Date
9/22/2008
1/7/2013
1/7/2013
1/7/2013
1/7/2013
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
2/15/2011 None
5/16/2012 None
7/4/2013 None
N/A
N/A
N/A
10/27/2010 None
8/31/2009 None
N/A
N/A
9/21/2011 None
N/A
6/4/2010 None
3/9/2012 None
N/A
N/A
9/15/2011
6/4/2010
3/1/2012
8/1/2013
FERNANDEZ, JIMMY DANIEL, MD
FETSAK, ANDRIY, MD
FINIANOS, ANTOINE NAFEZ
NAFEZ, MD
FLORES, RENEE J, MD
FOLARIN, HOPE, MD
FRANCIS, MAUREEN DOROTHY,
MD
11/4/2011
12/1/2010
8/21/2009
1/2/2012
7/15/2010
LIVINGSTON
DERBY
AUSTIN
TX
CT
TX
ACTIVE
ACTIVE
ACTIVE
8/26/2009 None
2/14/2012 None
7/21/2010 None
N/A
N/A
N/A
1/18/2011
EL PASO
TX
1/26/2011 None
N/A
2/5/2010
5/15/2012
2/5/2010 None
5/16/2012 None
N/A
N/A
8/16/2010
9/1/2010
EL PASO
LACKLAND
AFB
AUSTIN
TX
N7424
N7617
FRANCO, ZURISADAI, MD
FRIDAY, DWAYNE, MD
FURUKAWA, BRIAN SHIGENOBU,
MD
GALVAN, KRISTOFER ISAMU, MD
ACTIVE
LICENSE
ISSUED
ACTIVE
8/23/2010 None
10/22/2010 None
N/A
N/A
N6306
GARCIA, CESAR HUMBERTO, MD
6/4/2010
6/4/2010 None
N/A
P3328
P0587
GARCIA, CESAR JOSE, MD
GARG, MURARI, MD
6/1/2012
8/1/2011
Page 139 of 301
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/1/2012 None
8/9/2011 None
N/A
N/A
N6292
P2238
P7436
P1301
N8186
N3641
P1755
N7086
N8511
N5056
P3150
FELLMAN, KIM-NGAN PHAM, MD
FENG, ZICHUN , MD
FERGUSON, ANGELA GREMILLION,
DO
HOSPITALIST
HOSPITALIST
TX
TX
GERIATRICS
WAYCROSS
GA
8/5/2013 None
SEE
PREVIOUS
12/15/2011 ORDER
12/6/2010 None
N/A
11/16/2011
N/A
License
Number
P0588
P1308
Physician Name
edicaid
edicaid
End Date
Designated)
8/1/2011
11/4/2011
P6392
GARG, NADISH, MD
GARZA, JOSE E., MD
GASKIN, FREDERICK SPENCER,
MD
5/1/2013
N7088
GELLI, SREEDHAR, MD
7/15/2010
P0214
GEORGE, BRANNON EDWARD, MD
7/1/2011
N3664
P0592
GEORGE, MATHEWS LAL, MD
GEORGE, ROSHNY A, MD
8/21/2009
8/1/2011
P2857
P0388
N2525
GESLANI, GIOVANNI A, DO
GHADIMI-MAHANI, MOHSEN , MD
GHATTAMANENI, SWAPNA , MD
4/13/2012
7/15/2011
4/3/2009
N2527
N1645
GHAZI, SAMINA ANSAR, MD
GHITH, TAMIM , MD
P3531
GHOBADI, ARMIN , MD
P5066
GHOSH, LINA, MD
P5066
GHOSH, LINA, MD
P5066
GHOSH, LINA, MD
P1643
GO, JON AVERY TAN, MD
N7091
N7092
GODEY, SREEDEVI , MD
GOEL, SHIV KUMAR, MD
7/15/2010
7/15/2010
N5078
N9860
N7426
GOLESKI, MARK JOSEPH, MD
GOMAN, ELIZABETH J, MD
GOMEZ, MONICA MARIE, MD
2/5/2010
6/3/2011
8/16/2010
N9863
N9861
GONZALEZ FELDMAN, EDGARD
IVAN, MD
GONZALEZ, ADAN , MD
4/3/2009
6/8/2012
6/3/2011
6/3/2011
Secondary Specialty
(Self-Designated)
CARDIOLOGY
HOSPITALIST
ONCOLOGY
SEGUIN
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
DALLAS
TX
Practice City
Disciplinary
Status Date
8/1/2011 None
11/9/2011 None
N/A
N/A
5/7/2013 None
N/A
7/15/2010 None
N/A
7/8/2011 None
N/A
8/31/2009 None
8/8/2011 None
N/A
N/A
4/13/2012 None
8/25/2011 None
5/6/2009 None
N/A
N/A
N/A
HOUSTON
CORPUS
CHRISTI
TX
ACTIVE
TX
GALVESTON
SAN ANOTNIO
FARMINGTON
HILLS
ODESSA
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
MI
TX
ACTIVE
ACTIVE
6/11/2009 None
12/23/2008 None
N/A
N/A
TX
ACTIVE
6/26/2012 None
N/A
ACTIVE
12/19/2012 None
N/A
ACTIVE
12/19/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
12/19/2012 None
N/A
12/15/2011 None
N/A
7/15/2010 None
7/27/2010 None
N/A
N/A
2/5/2010 None
6/13/2011 None
9/2/2010 None
N/A
N/A
N/A
6/3/2011 None
6/13/2011 None
N/A
N/A
NEPHROLOGY
HEMATOLOGY/ONCO
LOGY
HOUSTON
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
SAN ANTONIO TX
KYLE
TX
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
Page 140 of 301
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANTONIO TX
LICENSE
ISSUED
ACTIVE
License
Number
P2860
P2249
Physician Name
edicaid
edicaid
End Date
Designated)
P3629
N8099
GONZALEZ, ENRIQUE , MD
GONZALEZ-AYALA, RAFAEL , MD
GOODMAN, SAMANTHA HIRSCH,
MD
GOODPASTOR, SARAH , MD
N6320
P5632
GOPATHI, SWAPNA KUMAR, MD
GORE, MEGHANA SANDEEP, MD
6/4/2010
3/1/2013
N5693
GOVINDU, RUKMA R, MD
4/9/2010
N6322
GOWDA, JEEVAN CHAYTHAN, MD
6/4/2010
P2862
N7268
N3692
P7451
GOWRIGARI, NEELIMA , MD
GOYAL, ANUPAMA ASHOK, MD
GRAHAM, ABRAM KEITH, DO
GRANT, WILLIAM NELSON III, MD
4/13/2012
8/2/2010
8/21/2009
8/1/2013
N9059
P6626
N1658
P1761
N7094
GRAY, ELIZABETH ANNE, MD
GREWAL, KUSHMIT SINGH, MD
GRIFFITH, NATHANIEL LEE, DO
GU, MELINDA MIN, MD
GUCE, GARRY MACASAET, MD
GUERRA GAROFALO, HECTOR
JUAN, MD
GUMMELT, KYLE LAMAR, DO
GUNTIPALLI, PRAVEEN KUMAR,
MD
GUPTA, ISHA, MD
GUPTA, NISHANT, MD
GUPTA, SACHIN, MD
N8009
P4653
P3336
P5638
P6173
P0393
N6333
N6883
P4761
P7771
J5778
GUPTA, SHILPA, DO
GUPTA, SONIKA, MD
GUPTA, SURESH C, MD
GUPTE, MANJUSHA ARUN, MD
GUTIERREZ, BERNARDO ALVARO,
MD
4/13/2012
3/1/2012
Secondary Specialty
(Self-Designated)
Practice City
EL PASO
Registration
Status of
Practice
Texas
State
License
TX
6/15/2012
4/13/2017
8/2/2015
8/21/2014
8/1/2018
WICHITA
FALLS
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
TX
TX
TX
TX
3/15/2011
5/15/2013
1/2/2012
7/15/2010
DALLAS
FORT WORTH
TAHOKA
COLLEGE
STATION
YUMA
EL PASO
HOUSTON
KAUFMAN
DALLAS
TX
PATERSON
PATERSON
DALLAS
NJ
NJ
TX
6/1/2012
3/1/2013
4/12/2013
7/15/2011
6/1/2017
3/1/2018
4/12/2018
7/15/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
6/4/2010
7/1/2010
11/1/2012
8/30/2013
6/4/2015
7/1/2015
11/1/2017
8/30/2018
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
HOSPITALIST
CARDIOLOGY
HOSPITALIST
AUSTIN
GERIATRICS INTERNAL MEDICINE TEMPLE
Page 141 of 301
TX
AZ
TX
TX
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
TX
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
4/13/2012 ORDER
4/16/2012
3/9/2012 None
N/A
6/15/2012 None
11/25/2010 None
N/A
N/A
6/4/2010 None
3/6/2013 None
N/A
N/A
5/3/2010 None
N/A
6/4/2010 None
N/A
4/13/2012
8/23/2010
8/26/2009
8/7/2013
None
None
None
None
N/A
N/A
N/A
N/A
4/14/2011
5/21/2013
3/4/2009
2/10/2012
7/19/2010
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
10/29/2010 None
10/18/2012 None
N/A
N/A
6/12/2012
4/29/2013
4/29/2013
7/21/2011
None
None
None
None
N/A
N/A
N/A
N/A
6/4/2010
7/23/2010
11/7/2012
9/9/2013
None
None
None
None
N/A
N/A
N/A
N/A
10/18/2011 None
N/A
License
Number
P7277
Physician Name
GUTIERREZ, MICHAEL JOSEPH,
MD
N6336
P3534
N7429
edicaid
edicaid
End Date
Designated)
7/15/2013
HAIDER, MUMNOON, MD
6/4/2010
HAJIRAWALA, MITABEN, MD
6/8/2012
P0401
HAJJAR, JOUD , MD
HAMILTON, TANISHA JAMARRIA,
MD
8/16/2010
7/15/2011
N1342
P0061
HAMMO BARAZI, MAHMOUD , MD
HANSON, JOSHUA THOMAS, MD
N8517
HARANATH, SAI PRASHANTH, MD
1/18/2011
P0405
7/15/2011
N4451
HARIRI, HOUSSAM YOUSSEF, MD
HARNESS-BRUMLEY, CAYCE
LYNN, MD
11/6/2009
P3341
P0730
HARRIS, MARCUS LAVELLE, MD
HASAN, SYED SAMIH, MD
6/1/2012
8/15/2011
N6347
HASNI, SYED SHAYAN AHMED, MD
6/4/2010
6/15/2011
Secondary Specialty
(Self-Designated)
Practice City
LAREDO
PALLIATIVE
MEDICINE
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/10/2013 None
N/A
6/4/2010 None
N/A
6/8/2012 None
N/A
TX
ACTIVE
9/6/2010 None
N/A
AUSTIN
TX
GERIATRIC
MEDICINE (INTERNAL
MED)
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
7/20/2011 None
N/A
ACTIVE
ACTIVE
10/20/2008 None
6/21/2011 None
N/A
N/A
HOSPITALIST
STAMFORD
CT
ACTIVE
1/21/2011 None
N/A
TEMPLE
TX
ACTIVE
7/20/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
11/17/2009 None
N/A
6/1/2012 None
8/29/2011 None
N/A
N/A
6/4/2010 None
N/A
8/26/2011 None
N/A
8/1/2013 None
N/A
7/11/2011 None
N/A
12/1/2010
10/22/2009
6/18/2012
10/20/2008
None
None
None
None
N/A
N/A
N/A
N/A
TEMPLE
TX
EMERGENCY
MEDICINE
P0831
HASSAN, AIMAN AMIN, MD
8/26/2011
P7457
HASSAN, SYED FAHIM, MD
8/1/2013
NEPHROLOGY
P0224
HATAHET, MOHAMAD HAZEM, MD
7/1/2011
NEPHROLOGY
TEMPLE
TX
L1068
N3724
P3344
N0827
HAYWARD, DAVID REVALL, MD
HE, CHENYIN , MD
HEINEN, ALLISON PAIGE, DO
HENNES, MAGDA MAHER, MD
12/1/2010
8/21/2009
6/1/2012
8/29/2008
12/1/2015
8/21/2014
6/1/2017
8/29/2013
HOSPITALIST
MANITOWOC
DALLAS
HOUSTON
DALLAS
WI
TX
TX
TX
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
N4468
HENNESSY, MARK EDWARD, MD
11/6/2009
LUMBERTON
NC
ACTIVE
11/17/2009 None
N/A
N7103
HERNANDEZ, JUAN ANTONIO, MD
7/15/2010
Page 142 of 301
ACTIVE
7/21/2010 None
N/A
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
License
Number
edicaid
edicaid
End Date
Designated)
P0406
Physician Name
HERNANDEZ, LILIA HORTENCIA,
MD
HERNANDEZ, LUIS FELIPE , DO
HERNANDEZ, TRACY JENNIFER,
MD
HERNANDEZ-ZHANG, MARY
CARMEN, MD
P3347
HERRERA, HENRY ROBERT JR, MD
6/1/2012
N9874
HIRAKI, STEPHANIE , DO
6/3/2011
P6416
N2563
N0829
N9456
P7778
N3734
HO, TONY TRAN, MD
HOANG, VU LINH, MD
HOHLT, RUSSELL WADE, MD
P1765
HOLT, OLAYINKA OMOWUNMI, MD
N5111
P1875
N7281
Secondary Specialty
(Self-Designated)
5/1/2013
4/3/2009
HOSPITALIST
8/29/2008
HOSPITALIST
7/15/2011
INTERNAL MEDICINE
PASASENA
TX
NACOGDOCH
ES
TX
DALLAS
TX
INFECTIOUS
DISEASES
4/15/2011
8/30/2013
8/21/2009
1/2/2012
NEPHROLOGY
HOOVER, ANNETTE LARIE, MD
HOREISH, ADAM, MD
HORN, RANDAL J, MD
2/5/2010
1/17/2012
8/2/2010
HOSPITALIST
N4480
HOSKINS, JOHN, MD
11/6/2009
P7783
HUANG, CHRISTINE, MD
8/30/2013
N0842
N7283
N9458
HUANG, CONWAY CANHUI, MD
HUANG, QIN , MD
HUBBLE, LEVI LEWIS, MD
8/29/2008
8/2/2010
4/15/2011
N6364
N3741
HUBER, JAY R, DO
HULL, JOSHUA , MD
6/4/2010
8/21/2009
N6367
N0844
P5646
HUSAIN, NISREEN, MD
HUSSAIN, RAHAT, MD
HUYNH, SUSAN LYNN, DO
6/4/2010
8/29/2008
3/1/2013
P7284
HYLTON, ALECIA ROSEMARIE, MD
IBE, CHIMKAMA NGOZI CYNTHIA,
MD
7/15/2013
9/1/2011
P0905
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
VICTORIA
GILBERT
PALESTINE
GASTROENTEROLOG
Y
AUSTIN
MANSFIELD
TEMPLE
TX
TX
AZ
TX
TX
TX
TX
FAMILY PRACTICE
HOSPITALIST
Page 143 of 301
TEMPLE
TX
HOUSTON
DALLAS
TX
TX
HOUSTON
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
ACTIVE
5/28/2013 None
4/10/2009 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
9/17/2008 None
N/A
7/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
6/11/2012 None
N/A
6/3/2011 None
N/A
4/15/2011 None
9/2/2013 None
9/15/2009 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/9/2012 None
N/A
2/5/2010 None
1/31/2012 None
8/5/2010 None
N/A
N/A
N/A
11/6/2009 None
N/A
8/30/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
9/5/2008 None
8/16/2010 None
4/21/2011 None
N/A
N/A
N/A
6/4/2010 None
9/2/2009 None
N/A
N/A
6/4/2010 None
9/26/2008 None
3/6/2013 None
N/A
N/A
N/A
7/15/2013 None
N/A
ACTIVE
9/29/2011 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
P2681
IBRAHIM, PARISA, MD
4/2/2012
P6000
4/1/2013
INTERNAL MEDICINE SIOUX CITY
P3356
P7285
P3172
IDAHOSA, VICTOR OMAMODE, MD
ILOCHONWU, IKECHUKWU
CHRISTIAN, MD
ILYAS, MUZNA ATIF, MD
IM, JIN SEON , MD
6/1/2012
7/15/2013
5/15/2012
KINGWOOD
N5123
N8932
IMAM, SYED ATHER, MD
IMANPOUR, JAFAR, MD
2/5/2010
3/1/2011
N9569
IRIBARREN, JUAN BAUTISTA, MD
ISKRENKO, ALEXANDER
VLADIMIROVICH, MD
5/2/2011
PULMONARY
MEDICINE
8/2/2010
HOSPITALIST
ISLAM, MAHMUDA, MD
ISMAAEL, THAYER GELIL KHALIL,
MD
7/15/2013
3/1/2013
N7285
P7287
P5649
N0849
Registration
Status of
Practice
Texas
State
License
INDIANAPOLIS IN
IA
TX
HOSPITALIST
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
4/10/2012 None
N/A
ACTIVE
4/22/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
6/18/2012 None
8/27/2013 None
5/21/2012 None
N/A
N/A
N/A
2/5/2010 None
4/28/2011 None
N/A
N/A
TX
ACTIVE
5/5/2011 None
N/A
SAN ANTONIO TX
WICHITA
FALLS
TX
ACTIVE
8/9/2010 None
N/A
ACTIVE
7/17/2013 None
N/A
ACTIVE
3/5/2013 None
N/A
INFECTIOUS
DISEASES
NASSAU BAY
TX
ACTIVE
9/5/2008 None
N/A
BEEVILLE
TX
ACTIVE
3/20/2009 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
1/3/2012 None
6/6/2012 None
N/A
N/A
2/5/2010 None
N/A
8/29/2008
2/6/2009
NEPHROLOGY
1/2/2012
5/1/2012
HOSPITALIST
2/5/2010
N7286
ISSA, HUSAM ISMAIL, MD
IZNAOLA ESQUIVEL, OSCAR
ALBERTO, MD
IZQUIERDO, MIGUEL ARMANDO,
MD
JABSHETTY, SANGMESH, MD
JACOBSON, TATIANA BORISOVNA
, MD
JADEGONDANAHALLI, JAI
PRAKASH BABU THIPPAIAH, MD
8/2/2010
HOSPITALIST
ODESSA
TX
ACTIVE
9/17/2010 None
N/A
P2127
JAFRI, SYED FARRUKH HASAN, MD
2/10/2012
HOSPITALIST
HARLINGEN
TX
ACTIVE
2/16/2012 None
N/A
P5087
JAGARLAMUDI, ANNAPURNA, MD
INTERNAL MEDICINE GALLIPOLIS
OH
ACTIVE
12/26/2012 None
N/A
P5087
ACTIVE
12/26/2012 None
N/A
P5087
12/26/2012 None
N/A
N9075
J7797
JAMAL, NAZNIN , MD
JAMALI, MEHRNAZ NICOLE, MD
ACTIVE
LICENSE
ISSUED
ACTIVE
3/15/2011 None
4/3/2013 None
N/A
N/A
N2126
P1770
P3008
N5127
3/15/2011
3/1/2013
Page 144 of 301
ALISO VIEJO
CA
License
Number
Physician Name
N7437
JAMEEL, ERUM, MD
P3358
JAMES, CLEVE ORIAN, MD
JAMULLAMUDI, JOSEPH
N8408
SADAYANAND, MD
N8796
P3175
P7472
JANJUA, AASIA D, MD
JARAMILLO, ELIZABETH , MD
JATSKIV, ANDREW , MD
P4462
JAVERI, HETA , MD
P2686
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
8/16/2010
6/1/2012
1/3/2011
2/15/2011
5/15/2012
8/1/2013
9/17/2012
JAWAID, FARRUKH, MD
4/2/2012
P5653
JAWED, SAMIHA, MD
3/1/2013
N1693
N8197
P1657
P1334
JENKINS, TREVOR L, MD
JOGGERST, STEVEN JAMES, MD
JOHN, ABRAHAM, MD
JOHN, RUBY SAMUEL, MD
P6838
JOHN, SUNITHA SARA, MD
P2128
N8409
N8018
JOHNSON, BOBBY SUDHIR, MD
JOHNSON, DAVID HORTON, MD
JOHNSON, EWAN DOUGLAS, MD
P6003
JOHNSON, JAMEEL RASHEED, MD
P3360
N7550
P6431
JOHNSON, KATIE , DO
JONES, OLGA STRUKOVA, MD
JOSEPH, JAMES , MD
N5137
P2014
N5141
12/1/2010
11/4/2011
6/3/2013
2/10/2012
1/3/2011
Practice City
DALLAS
STAFFORD
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
MESQUITE
TX
GERIATRICS
SAN ANTONIO TX
INFECTIOUS
DISEASES
SAN ANTONIO TX
DALLAS
HOUSTON
TX
TX
PLANO
TX
HOSPITALIST
PALLIATIVE
MEDICINE
HOSPITALIST
ONCOLOGY
ONCOLOGY
4/1/2013
6/1/2012
8/27/2010
5/1/2013
JUAREZ, IDA , MD
KAHN, BEN JARONG, MD
2/5/2010
2/1/2012
2/5/2010
CRITICAL CARE
MEDICINE (IM)
N6404
KALINA, AMY SUSAN, DO
KALUVAPALLE, JAYASANKAR
REDDY, MD
6/4/2010
NEPHROLOGY
P4876
KALYANASWAMY, NARMADHA, MD
Page 145 of 301
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
1/21/2011 None
N/A
2/15/2011 None
6/5/2012 None
8/9/2013 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
ACTIVE
ACTIVE
ACTIVE
10/8/2012 None
N/A
4/2/2012 None
N/A
3/1/2013 None
N/A
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
6/10/2013 None
N/A
2/17/2012 None
1/10/2011 None
11/5/2010 None
N/A
N/A
N/A
4/3/2013 None
N/A
6/1/2012 None
9/8/2010 None
5/10/2013 None
N/A
N/A
N/A
2/5/2010 None
2/3/2012 None
N/A
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
11/15/2012 None
N/A
EVERGREEN
PARK
DALLAS
TOMBALL
IL
TX
TX
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
ALEDO
EL PASO
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
CEDAR PARK
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/31/2010 None
N/A
6/15/2012 None
N/A
12/30/2009
12/13/2010
1/13/2012
11/16/2011
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P4769
KAMILI, QURAT-UL-AIN , MD
11/1/2012
P2273
KANCHERLA, DAYAKAR, MD
3/1/2012
N7816
P6653
KANDURU, CHAKRAVARTHY, MD
KANIN, ELENITA , MD
N7933
KANSARA, ABHISHEK HARESH, MD
P2274
N5759
N2138
KANURI, RAVI, MD
KAPUR, NITIN, MD
KAPUR, VISHAL, MD
P1882
KARTHIK, LAKSHMI, MD
P2697
N6412
N4511
10/1/2010
5/15/2013
1/17/2012
KARUTURI, MEGHAN SRI, MD
4/2/2012
KATKURI, RAJANI REDDY, MD
KAUR, BALJIT , MD
6/4/2010
11/6/2009
KAZA, VAIDEHI , MD
KEKAN, MANASI SUBHASH , MD
P3014
KELLY, JOHN MATTHEW, MD
Practice City
HOUSTON
TX
GASTROENTEROLOG
Y
HOUSTON
TX
3/1/2012
4/9/2010
2/6/2009
N3782
N4514
Secondary Specialty
(Self-Designated)
ALLERGY AND
IMMUNOLOGY
Registration
Status of
Practice
Texas
State
License
8/21/2009
11/6/2009
5/1/2012
HOUSTON
TX
GALVESTON TX
HUNTINGDON
VALLEY
PA
HOSPITALIST
HEMATOLOGY/ONCO
LOGY
HOUSTON
PULMONARY
CRITICAL CARE
MEDICINE
TX
DETROIT
MI
HOUSTON
TX
ALBUQUERQU
E
NM
GERIATRIC
MEDICINE (INTERNAL
MED)
P5658
P0244
P0743
P0987
KERWIN, DIANA ROSE, MD
KHAIR, TARIF HISHAM, MD
KHALID, BAZGHA, MD
KHALID, HAROON, MD
3/1/2013
7/1/2011
8/15/2011
9/15/2011
3/1/2018
7/1/2016
8/15/2016
9/15/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
P7656
P1339
N5769
N8673
KHALIL, QASIM, MD
KHALILI, HOUMAN , MD
KHAN, ABDUL Q, MD
KHAN, ALI AMIN, MD
8/15/2013
11/4/2011
4/9/2010
2/4/2011
8/15/2018
11/4/2016
4/9/2015
2/4/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
N8938
KHAN, DANISH , MD
3/1/2011
P5393
KHAN, FARHAN ANWAR, MD
2/1/2013
Page 146 of 301
HOSPITALIST
CARDIOLOGY
DALLAS
TX
LIVINGSTON
TX
KANSAS CITY KS
DALLAS
TX
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/10/2012 None
N/A
3/1/2012 None
N/A
10/1/2010 None
5/27/2013 None
N/A
N/A
10/15/2010 None
N/A
3/1/2012 None
4/23/2010 None
2/18/2009 None
N/A
N/A
N/A
ACTIVE
1/24/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/26/2012 None
N/A
6/4/2010 None
11/30/2009 None
N/A
N/A
ACTIVE
ACTIVE
9/1/2009 None
2/8/2010 None
N/A
N/A
ACTIVE
5/7/2012 None
N/A
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/1/2013
7/20/2011
9/2/2011
12/13/2011
None
None
None
None
N/A
N/A
N/A
N/A
8/15/2013
11/8/2011
4/22/2010
2/11/2011
None
None
None
None
N/A
N/A
N/A
N/A
3/1/2011 None
N/A
2/1/2013 None
N/A
License
Number
Physician Name
P1885
KHAN, IMRAN ANWAR, MD
KHAN, MOHAMMAD MAHMOOD,
N5771
MD
edicaid
edicaid
End Date
Designated)
1/17/2012
4/9/2010
4/2/2012
3/15/2011
2/10/2012
8/26/2011
7/1/2013
2/1/2012
Secondary Specialty
(Self-Designated)
HEMATOLOGY/ONCO
LOGY
P2703
N9080
P2136
P4661
P0842
P7136
P2021
KHAN, SOBIA, MD
KHAN, YASIR ARFAT, MD
KHANIJOW, VIKESH , MD
KHERADPOUR, RABIN, MD
KHIN, YU YU, MD
KIDWELL, DAVID THOMAS, MD
KIM, EDWARD , MD
N6423
P0246
KIM, YONG SIK, MD
KINNEY, BRANDON SCOTT, MD
6/4/2010
7/1/2011
N7293
P5400
KLAIR, NAVEED AHMAD, MD
KLEIN, JEFFREY ADAM, MD
8/2/2010
2/1/2013
N8676
KNECHT, JOHN GEORGE III, MD
2/4/2011
N5160
P5096
P5096
P5096
KOCHAR, TINA, MD
KOCUREK, EMILY GADDIS, MD
2/5/2010
NEPHROLOGY
N1714
N0900
KODURI, HEMANTHA KUMAR, MD
KOLLI, SUNIL CHOWDARY, MD
8/29/2008
HOSPITALIST
P6666
P0075
KOMMINENI, VIJAYA, MD
KORIMERLA, PRAVEEN
CHAKRAVARTHY, MD
GYNECOLOGY
N5161
P6850
KORIMILLI, VIJAY, MD
KORNSAWAD, KANAPA , MD
P6203
P4878
KOSHY, JANICE JOHN, MD
KOSHY, THOMAS PHILIP, MD
N6434
N7554
N4532
KOTHARI, AMIT JAGDISH, MD
KRACHMAN, BRIAN SCOTT, DO
KRISHNAMOORTHY, ARUN , MD
GARLAND
HOBBS
TEMPLE
CARDIOLOGY
AUSTIN
LAKE
JACKSON
DALLAS
5/15/2013
INTERNAL MEDICINE
6/15/2011
CARDIOLOGY
2/5/2010
6/3/2013
4/12/2013
6/4/2010
8/27/2010
11/6/2009
Practice City
EL PASO
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
ACTIVE
ACTIVE
NM
ACTIVE
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
TX
TX
DALLAS
DALLAS
DALLAS
TX
TX
TX
CHICAGO
MT. VERNON
IL
IL
SAN ANTONIO TX
INFECTIOUS
DISEASES
Page 147 of 301
DALLAS
TX
TYLER
DALLAS
TX
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/24/2012 None
N/A
4/9/2010 None
4/2/2012
4/6/2011
2/14/2012
10/25/2012
8/31/2011
7/5/2013
2/9/2012
N/A
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
6/4/2010 None
8/3/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
9/15/2010 None
2/6/2013 None
N/A
N/A
2/4/2011 None
N/A
2/5/2010
1/7/2013
1/7/2013
1/7/2013
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
3/9/2009 None
11/17/2008 None
N/A
N/A
5/15/2013 None
N/A
6/15/2011 None
N/A
2/5/2010 None
7/16/2013 None
N/A
N/A
4/12/2013 None
11/19/2012 None
N/A
N/A
6/4/2010 None
9/2/2010 None
11/13/2009 None
N/A
N/A
N/A
License
Number
N5167
Physician Name
edicaid
edicaid
End Date
Designated)
2/5/2010
3/15/2011
4/12/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
N9085
P6205
KUDYADI, DEEPTI SATISH, MD
KUERSTEINER, ANNAMARIA
MACALUSO, MD
KUMAR, AMITA, MD
P1095
N8204
P4879
KUNIYIL, JESHEEJA, MD
KURIAN, ASHA MARY, MD
KUYE, TAIWO ADEYINKA, MD
P0424
P0251
N7825
KWAN, CHRISTINE, MD
LADHA, MALIK MOLEDINA, MD
LAKHIA, RONAK , MD
7/15/2011
7/1/2011
10/1/2010
N7633
LALANI, FARHAN FAROOQ, MD
9/1/2010
N2874
P2715
N4539
N1378
LANGELAND, DAWN TU-DONG, MD
LARIOS, PATRICIA , MD
LATHROP, KATE IDA, MD
LAUREL, PATRICIA , MD
P5667
N7302
LAVIOLETTE, JUDY DERRICK, MD
LAXMISAN, ARCHANA, MD
3/1/2013
8/2/2010
SHREVEPORT LA
TX
K5140
LAZARO, LARRY RIVERA, MD
7/1/2011
HOSPITALIST
N7129
P1779
LE, DAN, MD
LEAK, MORGAN GRANT, MD
7/15/2010
1/2/2012
N6453
LEE, GRACE LAUREN, MD
6/4/2010
P7143
N3828
LEE, SABINA MIKYONG, MD
LEWIS, NEIL PENDRIL , MD
7/1/2013
8/21/2009
P6858
P7800
N9591
P6859
N1739
P6860
LI, HUAIGUANG, MD
LIANG, MIN , MD
LINDSAY, JOHN KRISTIAN, MD
LINGAM, PRANATHI , MD
LIU, YINGHUI , MD
LIWAG, NOAH ABILLE, MD
10/3/2011
12/1/2010
4/3/2009
4/3/2014
4/2/2012
4/2/2017
11/6/2009
11/6/2014
10/10/2008 10/10/2013
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
LEXINGTON
STATEN
ISLAND
EL PASO
HARLINGEN
KY
BRYAN
HOUSTON
TX
TX
SAN ANTONIO
DALLAS
SAN ANTONIO
SAN ANTONIO
INFECTIOUS
DISEASES
CARDIOLOGY
NY
TX
TX
TX
TX
TX
TX
REMUS
MI
AMARILLO
TX
HOUSTON
AUSTIN
6/3/2013
8/30/2013
5/2/2011
TEMPLE
6/3/2013
12/12/2008 12/12/2013 INTERNAL MEDICINE INTERNAL MEDICINE DALLAS
6/3/2013
Page 148 of 301
TX
TX
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
4/4/2011 None
4/22/2013 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
10/26/2011 None
12/23/2010 None
11/21/2012 None
N/A
N/A
N/A
7/15/2011 None
7/6/2011 None
10/20/2010 None
N/A
N/A
N/A
9/1/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/14/2009
4/4/2012
11/25/2009
10/27/2008
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
None
None
None
None
N/A
N/A
N/A
N/A
3/8/2013 None
9/6/2010 None
N/A
N/A
7/1/2011 None
N/A
7/15/2010 None
1/23/2012 None
N/A
N/A
6/4/2010 None
N/A
7/1/2013 None
9/3/2009 None
N/A
N/A
6/3/2013
9/6/2013
5/26/2011
6/28/2013
12/18/2008
6/12/2013
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
License
Number
Physician Name
N8212
LLEMIT, SHARIFA , MD
LOCKRIDGE, JOSEPH BRENDAN,
N8418
MD
N8214
P4778
LONGORIA, RODOLFO, MD
LOPEZ-LLADO, SARA M, MD
P3032
LOU, YANYAN , MD
N3151
N4560
P0992
P4779
P7803
P6214
LOVELACE, AKINYELE KAMAU , DO
LOW, LEAH ELIZABETH, MD
LU, LINH M, DO
LUGO, ESMERALDA , MD
LUPTON, DREW TAYLOR, DO
MACEDO, FRANCISCO YURI
BULCAO, MD
H8736
N5211
edicaid
edicaid
End Date
Designated)
12/1/2010
1/3/2011
12/1/2010
11/1/2012
5/1/2012
5/29/2009
11/6/2009
9/15/2011
11/1/2012
8/30/2013
5/29/2014
11/6/2014
9/15/2016
11/1/2017
8/30/2018
4/12/2013
MACKENZIE, JOHN STUART, DO
4/3/2009
MADANI, BAHAR, MD
2/5/2010
P3385
MADAPPA, TARUN, MD
N8811
MADARANG, ERIC LEE, DO
MADHAVAN, RANGANATHAN
GURU, MD
MADNI, SYED A, MD
2/15/2011
8/15/2011
4/1/2013
MAHMUD, HINA, MD
MAIDA, MAHAMADU ABDULFATAHU, MD
8/21/2009
11/6/2009
2/15/2011
8/16/2010
P1099
P4480
MAILLOUX, BREION , DO
MAINALI, DINESH, MD
MAKAM, RAGHAVENDRA CHARAN
PARTHASARATHI, MD
MAKHLOUF, TONY , MD
10/3/2011
9/17/2012
N5214
N7455
MALHOTRA, ADVITYA , MD
MALIAKKAL, MAMMEN , MD
2/5/2010
8/16/2010
N3852
N4569
N8813
N7453
INTERNAL MED EMERGENCY MED
Practice City
HOUSTON
DALLAS
BROWNSVILL
E
TX
SAN ANTONIO TX
CARDIOLOGY
EMERGENCY
MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/14/2010 None
N/A
1/3/2011 None
N/A
ACTIVE
ACTIVE
12/7/2010 None
12/3/2012 None
N/A
N/A
TX
ACTIVE
5/8/2012 None
N/A
HEREFORD
TX
GALVESTON TX
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/28/2009
1/5/2010
9/19/2011
11/5/2012
9/4/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
MIAMI
FL
ACTIVE
4/15/2013 None
N/A
ROWLETT
TX
ACTIVE
LICENSE
ISSUED
10/14/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/26/2012 None
N/A
2/15/2011 None
N/A
8/15/2011 None
4/5/2013 None
N/A
N/A
ACTIVE
9/23/2009 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
11/16/2009 None
N/A
2/15/2011 None
8/23/2010 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
10/13/2011 None
12/5/2012 None
N/A
N/A
2/5/2010 None
8/24/2010 None
N/A
N/A
HEMATOLOGY/ONCO
LOGY
HOUSTON
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
6/1/2012
P0757
P6023
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
TX
ISSUED
CORPUS
CHRISTI
TX
HOSPITALIST
HOSPITALIST
DANBURY
CT
GERIATRICS INTERNAL MEDICINE FOREST PARK IL
HUMBLE
INTERNAL MEDICINE WESTFIELD
HENDERSON
HOSPITALIST
RIO RANCHO
GASTROENTEROLOG
2/5/2015 INTERNAL MEDICINE Y
8/16/2015 INTERNAL MEDICINE PEDIATRICS
AUSTIN
Page 149 of 301
TX
MA
TX
NM
TX
License
Number
Physician Name
P7307
MALIK, AMYN, MD
N6470
MALIK, ANUJ , MD
P0994
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
7/15/2013
6/4/2010
MALIK, MOHAMMAD IBRAHIM, MD
9/15/2011
P6024
N0942
MALIK, OSMAN , MD
MALSAM, ERIC JOHN, MD
4/1/2013
8/29/2008
P3037
MAMILLAPALLI, PADMAJA DEVI, MD
5/1/2012
P3387
MANEK, NEIL RAMESH, MD
6/1/2012
N9595
MANGAT, MANPREET, MD
5/2/2011
P2727
P4481
4/2/2012
9/17/2012
P6026
P5678
MANKIDY, BABITH JOSEPH, MD
MANNE, HARI KRISHNA, MD
MANZANO, JOANNA GRACE MAYO,
MD
MAPAKSHI, NANDANA, MD
NEPHROLOGY
PULMONARY
CRITICAL CARE
MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
HOSPITALIST
4/1/2013
3/1/2013
NEPHROLOGY
P7665
P2729
MARAKATHAM, SREEDEVI, MD
MARINA, SHADI, MD
8/15/2013
4/2/2012
P7309
MARTIN, DONALD JOSEPH, MD
7/15/2013
P7500
MARTIN, ERIC BRANDON, MD
8/1/2013
N7140
MARTIN, JASON LEE, MD
7/15/2010
N6475
MARTIN, MICHAEL COLIN, MD
6/4/2010
N5843
MARTINEZ, SYLVIA AMADOR, MD
MARTINEZ-OCHOA, JOSE
RODRIGO, MD
MASEK, JEANETTE L, MD
MASOOD, FARAH , MD
4/9/2010
6/15/2011
8/16/2010
12/1/2011
P0093
F9784
P1567
HOSPITALIST
PULMONARY
CRITICAL CARE
MEDICINE
Practice City
GRAPEVINE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/14/2013 None
N/A
6/4/2010 None
N/A
WACO
TX
ACTIVE
10/17/2011 None
N/A
FALLS
CHURCH
AUSTIN
VA
TX
ACTIVE
ACTIVE
4/8/2013 None
9/9/2008 None
N/A
N/A
BRYN MAWR
PA
ACTIVE
LICENSE
ISSUED
6/1/2012 None
N/A
6/1/2012 None
N/A
THE
WOODLANDS TX
ACTIVE
6/14/2011 None
N/A
FARGO
ND
ACTIVE
ACTIVE
4/5/2012 None
10/8/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/18/2013 None
4/11/2013 None
N/A
N/A
8/15/2013 None
4/9/2012 None
N/A
N/A
7/15/2013 None
N/A
8/1/2013 None
N/A
7/15/2010 None
N/A
6/4/2010 None
N/A
4/9/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
6/21/2011 None
8/30/2010 None
12/9/2011 None
N/A
N/A
N/A
HOSPITALIST
ROCKFORD
GASTROENTEROLOG
Y
Page 150 of 301
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
AUSTIN
NEW YORK
KERRVILLE
IL
TX
NY
TX
License
Number
P2145
P4675
Physician Name
edicaid
edicaid
End Date
Designated)
P7503
P1197
N8320
P1568
P3041
P1198
MASOODI, NASSEER A, MD
MASRUR, FATIMA, MD
MASSUMI, MAHSA ABOLFATHIAN,
MD
MATADEEN-ALI, CHANDRA, MD
MATHEW, MINI ANN, DO
MATHEW, PAUL, MD
MATUS, HEIDI L, MD
MAVANI, GAURANG P, MD
2/10/2012
P0441
N9264
MAYS, RANA MAJD, MD
MAYYA, SHARAT, MD
N5854
P5292
MCCUAN, CLAYTON ALAN, DO
MEGHAPARA, BHAVINKUMAR K,
MD
P7508
N1393
MEHTA, MANISHA SHIVANG, DO
MEHTA, SACHIN , MD
8/1/2013
P4890
P6221
N7311
4/12/2013
8/2/2010
N7144
MEKETE, BAHIRU BELACHEW, MD
MELEK, JOHN, MD
MELENDEZ, JOSE A, MD
MENDEZ-RAMIREZ, JOSE MARIA,
MD
N5865
MENDLER, THOMAS MICHAEL, MD
N1764
N4585
MENES, STEPHANIE IFEOMA, MD
MESARWI, OMAR , MD
P2732
MESHRAM, SHEETAL , MD
8/1/2013
12/1/2011
5/1/2012
Secondary Specialty
(Self-Designated)
Practice City
HOSPITALIST
ROCHESTER
SLEEP MEDICINE
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
1/22/2013 None
N/A
8/1/2013 None
12/9/2008 None
N/A
N/A
HOSPITALIST
BAKERSFIELD CA
NEPHROLOGY
CARDIOLOGY
HOUSTON
TX
LAWTON
OK
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
11/20/2012 None
4/24/2013 None
8/10/2010 None
N/A
N/A
N/A
EL PASO
TX
ACTIVE
7/26/2010 None
N/A
HOUSTON
TX
ACTIVE
4/15/2010 None
N/A
MANSFIELD
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
2/23/2009 None
1/6/2010 None
N/A
N/A
4/2/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/10/2008 None
8/16/2013 None
N/A
N/A
2/5/2010 None
N/A
7/1/2010 None
N/A
MININA, IRINA ANATOLIYEVNA, MD
MINN, CHARLES KEE JOON, MD
8/29/2008
8/1/2013
NEPHROLOGY
N5247
MIRANDA, MARY ANN VENITA, MD
2/5/2010
HOSPITALIST
N6930
MIRYALA, REKHA, MD
7/1/2010
Page 151 of 301
N/A
N/A
N/A
N/A
N/A
N/A
4/9/2010 None
N0982
P7514
None
None
None
None
None
None
N/A
N/A
1/15/2013
4/2/2012
8/5/2013
10/21/2011
12/28/2010
12/6/2011
5/3/2012
10/24/2011
7/20/2011 None
4/20/2011 None
HOSPITALIST
11/6/2009
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
2/10/2012 None
11/12/2012 None
TX
TX
4/9/2010
4/9/2010
Disciplinary
Status Date
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
PA
TX
NM
TX
LA
7/15/2011
4/1/2011
7/15/2010
DERMATOLOGY
HOSPITALIST
HOUSTON
GLEN MILLS
TEMPLE
LAS CRUCES
HOUSTON
ALEXANDRIA
451 N. TEXAS
AVE
DALLAS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
NY
ACTIVE
BROWNSVILL
E
TX
HOUSTON
TX
License
Number
N9910
N8424
Physician Name
edicaid
edicaid
End Date
Designated)
N7948
MIRZA, KHURRAM REHMAN, MD
MITCHELL, ANGELA HEAPE, MD
MITRA, RANJANA NEELANJANA,
MD
N6498
MITTAL, RICHA, MD
6/4/2010
N5873
MOAMMAR, OUSAMA, MD
4/9/2010
N8225
P4788
N2197
12/1/2010
11/1/2012
2/6/2009
3/1/2012
P0445
N6933
N9750
N2672
MOHAMMAD, AMAL OTHMAN, MD
MOHAN, KRISHN , MD
MOKWE, EVAN O, MD
MOLINA ROJO, JOANNA ESTHER,
MD
MONTANA DE LA CADENA, PAULA
ANDREA, MD
MOPARTY, DEEPA REDDY, MD
MORAN, JENNIFER DAWN, MD
MORE, ELIZABETH VON, MD
7/15/2011
7/1/2010
5/16/2011
4/3/2009
7/15/2016
7/1/2015
5/16/2016
4/3/2014
N9471
P4488
MOREL, JOSE BETHOVEN, MD
MORRIS, EVELYN LETHITIA, MD
4/15/2011
9/17/2012
N9916
P5212
MORROW, JASON, MD
MOVVA, SUDHIR BABU, MD
6/3/2011
1/4/2013
K0143
3/15/2013
N5268
P0770
P4987
P5692
MUENS, GUENTHER, MD
MUMMADI, VIJAYA LAKSHMI-DEVI,
MD
MUNDRA, VISHAL, MD
MUSTAFA, ARSHAD , MD
MUTHAPPA, DIVYA, MD
N7847
NABBOUT, LARA , MD
N5897
NAEEM, MUHAMMAD, MD
N8549
NAEEM, SAIMA, MD
N5898
NAEEM, SAJIDA NIGHAT, MD
P2305
6/3/2011
1/3/2011
Secondary Specialty
(Self-Designated)
HOSPITALIST
HOSPITALIST
10/1/2010
4/9/2010
1/18/2011
4/9/2010
AUSTIN
HOSPITALIST
CARDIOLOGY
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
2/5/2010
8/15/2011
3/1/2013
Practice City
UVALDE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
LICENSE
TX
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
SAN ANTONIO TX
GERIATRICS
PALLIATIVE
MEDICINE
NEPHROLOGY
URGENT CARE
MEDICINE
TEMPLE
KYLE
TX
TX
WORCESTER
MA
N/A
N/A
10/15/2010 None
N/A
6/4/2010 None
N/A
4/9/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
12/6/2010 None
11/15/2012 None
3/2/2009 None
N/A
N/A
N/A
ACTIVE
3/13/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
7/21/2011
7/16/2010
5/20/2011
4/30/2009
None
None
None
None
N/A
N/A
N/A
N/A
4/15/2011 None
10/11/2012 None
N/A
N/A
6/14/2011 None
1/9/2013 None
N/A
N/A
4/1/2013 None
N/A
ACTIVE
ACTIVE
SILVERDALE
WA
TULSA
DALLAS
BANDERA
OK
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
GERIATRICS INTERNAL MEDICINE HOUSTON
TX
HOSPITALIST
Page 152 of 301
Disciplinary
Status Date
6/3/2011 None
1/7/2011 None
SAN ANTONIO TX
RUTLAND
VT
NUCLEAR MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
2/5/2010
8/19/2011
12/10/2012
3/8/2013
None
None
None
None
N/A
N/A
N/A
N/A
10/19/2010 None
N/A
4/9/2010 None
N/A
1/18/2011 None
N/A
4/9/2010 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P3556
N3925
N3926
N3927
P0917
NAGARAJ, SUDHA, MD
NAHAR, JANE , MD
NAHAR, JULIE , MD
NAHAR, RUBY , MD
NAIK, JAEE, MD
6/8/2012
8/21/2009
8/21/2009
8/21/2009
9/1/2011
6/8/2017
8/21/2014
8/21/2014
8/21/2014
9/1/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
P7679
8/15/2013
N8129
NAIK, SEEMA GIRISH, MD
NAIR, ARCHANA UNNIKRISHNAN,
MD
N6523
N3203
NAIR, KIRAN DEV, DO
NAIR, SINDHU , MD
6/4/2010
5/29/2009
N3204
NAIR, SUNEESH GOPALAN , MD
5/29/2009
N5273
P1904
NALLAGATLA, SASIKANTH, MD
NAQVI, ERUM, MD
2/5/2010
1/17/2012
P3394
NATARAJAN, BALAKRISHNAN, MD
6/1/2012
N7468
N9392
NAVARRO, ALEXANDER MA, MD
NAYAK, TANAYA, MD
8/16/2010
4/8/2011
P7320
P4896
P0919
NAYAR, TUSHAR, MD
NAZ, TABASSUM, MD
NAZHA, AZIZ , MD
7/15/2013
9/1/2011
P6225
N9921
P5694
P6687
N6943
P4897
P4493
N3946
N9275
NEELAND, IAN JASON, MD
NEGI, SMITA INDRASINGH, MD
NGO, THUY-TRANG THI, MD
NGUYEN, ANDY HUY, DO
NGUYEN, CHARLES MINH, MD
NGUYEN, DAT, DO
NGUYEN, KIM YEN THI, MD
NGUYEN, KIMTUYEN NGOC, MD
NGUYEN, QUAN TRUNG, DO
4/12/2013
6/3/2011
3/1/2013
5/15/2013
7/1/2010
9/17/2012
8/21/2009
4/1/2011
Secondary Specialty
(Self-Designated)
Practice City
TULSA
TULSA
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
OK
ACTIVE
OK
ACTIVE
ACTIVE
ACTIVE
GERIATRICS
HEMATOLOGY INTERNAL MEDICINE SAN ANTONIO TX
GERIATRICS
WOODLANDS TX
HOSPITALIST
HOUSTON
TX
PULMONARY
CRITICAL CARE
MEDICINE
HOUSTON
TX
PULMONARY
CRITICAL CARE
MEDICINE
HOSPITALIST
SAN ANTONIO TX
PALLIATIVE
MEDICINE
GERIATRIC
MEDICINE (INTERNAL
MED)
HOSPITALIST
CARDIOVASCULAR
DISEASES
DALLAS
CARDIOLOGY
HOUSTON
TX
TX
TX
HOSPITALIST
FORT WORTH TX
PEARLAND
TX
DALLAS
TX
INTERNAL MEDICINE
Page 153 of 301
ACTIVE
Registration
Status Date
6/8/2012
9/11/2009
9/30/2009
10/5/2009
9/9/2011
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
8/20/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
1/5/2011 None
N/A
6/4/2010 None
6/26/2009 None
N/A
N/A
ACTIVE
6/19/2009 None
N/A
2/5/2010 None
1/31/2012 None
N/A
N/A
6/1/2012 None
N/A
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/16/2010 None
4/21/2011 None
N/A
N/A
7/15/2013 None
12/17/2012 None
9/13/2011 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/16/2013
6/13/2011
3/6/2013
5/20/2013
7/13/2010
12/3/2012
10/10/2012
9/15/2009
4/22/2011
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
None
None
None
None
None
None
None
None
None
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N6537
P5856
P0643
N4622
N5912
N3952
NGUYEN, TRUNG HIEU, MD
NIAZI, NADIA, MD
NIGAM, RUPESH , MD
NIKAM, NAVIN SRINIVAS, MD
NORMAN, NATALIE DIANNE, MD
NUILA, RICARDO ERNESTO, MD
6/4/2010
3/15/2013
8/1/2011
11/6/2009
4/9/2010
8/21/2009
6/4/2015
3/15/2018
8/1/2016
11/6/2014
4/9/2015
8/21/2014
P1572
NUSBAUM, DEREK MATTHEW, MD
NWABUDE, IKECHUKWU
ALOYSIUS, MD
12/1/2011
2/5/2010
N5288
P4686
P2907
NWACHUKWU, CHISOM DAISY, MD
NWANKWO, CHRISTIAN CHIDUBE,
MD
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
4/13/2012
2/5/2010
3/1/2013
N2694
OBAFEMI, ADEBISI IDOWU, MD
OCHOA, JOSE MARIA IV, MD
ODULAJA, KOLAWOLE
ADEMUYIWA, MD
4/3/2009
N6544
OFORI, STANLEY, MD
6/4/2010
N9927
OGBONNA, MARTINA, MD
6/3/2011
P7826
OGBU, CHIJIOKE EJIOFOR, MD
8/30/2013
N5293
OGUNFUWA, ADEKUNLE SUNDAY,
MD
2/5/2010
N5292
P5696
P2152
N5920
OI, SEIJO, MD
OKOLO, EKENE IFEANYI, MD
P2045
OKONKWO, FRANCIS ARINZE, MD
OLADELE-AJOSE, OLUFEMI
TAIWO, MD
OLALOWO, OLOYEDE OLABODE,
MD
OLARTE MERIDA, KAREN EVELIN,
MD
N9394
P2908
P5442
2/10/2012
4/9/2010
2/1/2012
4/8/2011
4/13/2012
2/1/2013
Secondary Specialty
(Self-Designated)
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
TX
ACTIVE
ACTIVE
TX
ACTIVE
HOUSTON
TX
Practice City
INTERNAL MEDICINE
NEPHROLOGY
HOUSTON
DALLAS
HOSPITALIST
NEPHROLOGY
ST. LOUIS
MO
TEMPLE
TX
GERIATRICS
HOSPITALIST
NEPHROLOGY
GERIATRIC
MEDICINE (INTERNAL
MED)
PULMONARY
MEDICINE
EMERGENCY
MEDICINE
N/A
N/A
N/A
N/A
N/A
N/A
12/16/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
11/6/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/23/2012 None
N/A
2/5/2010 None
3/6/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/13/2009 None
N/A
6/4/2010 None
N/A
6/3/2011 None
N/A
8/30/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
6/4/2010
3/20/2013
8/8/2011
11/25/2009
4/22/2010
9/22/2009
Disciplinary
Status Date
None
None
None
None
None
None
LICENSE
ISSUED
KERRVILLE
TUCSON
TX
AZ
ACTIVE
ACTIVE
2/5/2010 None
SEE
PREVIOUS
2/21/2012 ORDER
4/23/2010 None
FORT SMITH
WEST
BURLINGTON
AR
ACTIVE
2/20/2012 None
N/A
IA
ACTIVE
LICENSE
ISSUED
4/20/2011 None
N/A
4/13/2012 None
N/A
2/7/2013 None
N/A
INTERNAL MEDICINE
Page 154 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
DETROIT
MI
ACTIVE
2/13/2012
N/A
License
Number
P1121
N8232
Physician Name
OLOSUNDE, AYOTOKUNBO
OLAITAN, MD
OLYMPIA, CHRISTIAN LOMIO, MD
N5295
ONOCHIE, NNENNA NKIRU, MD
N8829
N7853
N5297
N7854
N2702
N9759
N4642
P7176
P1381
N7471
edicaid
edicaid
End Date
Designated)
10/3/2011
12/1/2010
2/5/2010
ONYEBUEKE, IKENNA FELIX, MD
2/15/2011
OOMMEN, SMITHA ELIZABETH, MD
10/1/2010
2/5/2010
10/1/2010
4/3/2009
OPARA, EMMANUEL CHIWUEZE,
MD
ORDINARIO, MARIA MARGARITA,
MD
OSOWO, AYODELE TEMITOPE, MD
OSUCHUKWU, GEORGE AMECHI,
MD
OSWAL, ALOK , MD
OTERO LUGO, ARLYN , MD
OTULANA, OLAKUMBI B, DO
P0110
P3215
P1802
OVALLE, ALEJANDRO , MD
OYEKANMI, OYEKUNLE
ADEBOWALE, MD
PAGAN, SHARON JAELL, MD
PAING, SOE, MD
P1803
5/16/2011
11/6/2009
7/1/2013
11/4/2011
5/16/2016
11/6/2014
7/1/2018
11/4/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
8/16/2010
6/15/2011
5/15/2012
1/2/2012
PALACIO, CARLOS ANDRES, MD
1/2/2012
P7178
P0649
PAN, RUTH, MD
PANDIAN, ANBU VALAVAN, MD
7/1/2013
8/1/2011
N5312
PANDYA, HIMANSHU , MD
2/5/2010
P1382
PANDYA, SUNIL RAMESH, MD
PANTOJA ROJAS, CELIA ESTELA,
MD
11/4/2011
2/5/2010
N5314
Secondary Specialty
(Self-Designated)
GASTROENTEROLOG
Y
Practice City
EULESS
HOSPITALIST
PULMONARY
CRITICAL CARE
MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ONCOLOGY
GALVESTON
GERIATRIC
MEDICINE (INTERNAL
MED)
HOUSTON
TX
LICENSE
ISSUED
LICENSE
ISSUED
TX
NEPHROLOGY
MCKINNEY
HARLINGEN
TX
TX
OCCUPATIONAL
MEDICINE
HOSPITALIST
INTERNAL MED PREV MED
INTERNAL MEDICINE
Page 155 of 301
ABILENE
LACONIA
HOUSTON
TEMPLE
ACTIVE
TX
NH
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/3/2011 None
12/14/2010 None
N/A
N/A
2/5/2010 None
N/A
2/15/2011 None
N/A
10/13/2010 None
N/A
2/5/2010 None
N/A
10/1/2010 None
N/A
9/9/2009 None
N/A
5/16/2011
11/24/2009
8/27/2013
11/11/2011
None
None
None
None
N/A
N/A
N/A
N/A
8/16/2010 None
N/A
6/15/2011 None
5/17/2012 None
1/9/2012 None
N/A
N/A
N/A
1/2/2012 None
N/A
7/12/2013 None
8/5/2011 None
N/A
N/A
2/5/2010 None
N/A
11/4/2011 None
N/A
2/5/2010 None
N/A
License
Number
N2230
Physician Name
P0650
P1804
PANWAR, MONICA , MD
PARDO RUIZ, FERNANDO JAVIER,
MD
PAREDES, JOHN ENRIQUE, DO
PAREKH, NINAD DHANVANTRAY,
MD
PARIKH, ARCHANA ARPIT, MD
P5221
P1913
P7687
N8334
PARIKH, GAURAV, MD
PARIKH, MAMTA HARISH, MD
PASHAEI, HAMED, MD
PASSI, KAPIL, MD
N3974
PATAKOTI, RAMU, MD
N8965
P6885
edicaid
edicaid
End Date
Designated)
2/6/2009
3/1/2011
6/3/2013
8/1/2011
1/2/2012
1/4/2013
1/4/2018
1/17/2012
1/17/2017
8/15/2013
8/15/2018
12/15/2010 12/15/2015
8/21/2009
8/29/2008
9/17/2012
N1046
N7649
P7182
N6952
P5703
PATEL, ANKIT ARVINDBHAI, MD
PATEL, KALPESH P, MD
PATEL, KAUSHAL , MD
PATEL, KETUL RAJANIKANT, MD
PATEL, KIRTAN S, MD
8/29/2008
9/1/2010
7/1/2013
7/1/2010
3/1/2013
8/29/2013
9/1/2015
7/1/2018
7/1/2015
3/1/2018
P5869
PATEL, MANISHA NILESH, MD
3/15/2013
P7689
PATEL, SHRESTHA DILIPBHAI, DO
PATEL, TEJAS
PURUSHOTTAMBHAI, MD
PATEL, VIVEK AMRAT, MD
PATHAK, LAKSHMI KANT, MD
PATIL, SACHIN MALLANAGOUDA,
MD
8/15/2013
7/15/2010
4/3/2009
8/2/2010
7/1/2011
P6887
N1053
PATTARINI, JAMES MARTIN, MD
PAWAR, SANJEEV MADHAV, MD
6/3/2013
8/29/2008
P0922
PEARCE, STEVEN GABRIEL, MD
9/1/2011
HOSPITALIST
EL PASO
LONGVIEW
WICHITA
FALLS
PLANO
DALLAS
TX
TX
ACTIVE
ACTIVE
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
DELINQUEN
T-NON
PAYMENT
TX
PATALAY, MADHU KUMAR, MD
PATEL, AKASH MAHENDRA, MD
P0270
Practice City
INFECTIOUS
DISEASES
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
N1044
P4496
N7159
N2720
N7326
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
DELINQUEN
T-NON
PAYMENT
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
CARDIOVASCULAR
IMAGING
HOSPITALIST
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/7/2009 None
N/A
3/14/2011 None
6/5/2013 None
N/A
N/A
8/5/2011 None
1/9/2012 None
N/A
N/A
1/4/2013
1/23/2012
8/29/2013
12/27/2010
None
None
None
None
N/A
N/A
N/A
N/A
11/19/2009 None
N/A
WICHITA
FALLS
TX
ACTIVE
ACTIVE
9/24/2008 None
9/19/2012 None
N/A
N/A
CHAPEL HILL
NC
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
9/18/2008
9/21/2010
7/2/2013
7/7/2010
3/11/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
3/15/2013 None
N/A
TX
ACTIVE
8/23/2013 None
N/A
SAN ANTONIO TX
DALLAS
TX
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
7/26/2010 None
4/13/2009 None
8/5/2010 None
N/A
N/A
N/A
ACTIVE
7/8/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
6/11/2013 None
9/18/2008 None
N/A
N/A
TX
ACTIVE
9/23/2011 None
N/A
GENERAL PRACTICE GALVESTON
AEROSPACE
6/3/2018 INTERNAL MEDICINE MEDICINE
GALVESTON
PALESTINE,
GASTROENTEROLOG
9/1/2016 INTERNAL MEDICINE Y
HOUSTON
Page 156 of 301
License
Number
N1057
Physician Name
edicaid
edicaid
End Date
Designated)
N5331
P0272
PENA, ANTONIO , MD
PERDON, MICHAEL ARDEN
GOMEZ, MD
PERROTTE, NICOLE TAHIRA, MD
P2757
PHAM, TRUC THI THU, MD
4/2/2012
N6962
P2340
P3565
PHAM-HILL, TRAM BAO, MD
PHAN, DUC HONG, MD
PHILIP, LEENA, MD
7/1/2010
3/1/2012
6/8/2012
N9765
N1836
P1387
PHILLIPS, JACQUELINE MARIE, DO
PHILLIPS, JAN ELIZABETH, MD
PHUAH, ELAINE IE LIN, DO
PIDLAOAN, VICTORIO PARAYNO,
MD
PILLAI, SANGEETHA R, MD
PILLAI, SUJESH SATHYAN , MD
POKHAREL, YASHASHWI, MD
P7538
N8236
N4670
P6248
N8707
N7328
P3228
N7741
N5342
N4007
P1390
N5955
N1085
P3567
N1842
PORRES AGUILAR, MATEO , MD
POTAKAMURI, LAKSHMI
NARAYANA, MD
PUNJABI BAJPAI, ANITA , DO
PUNNOOSE, JENNIFER , MD
QAMAR, MUHAMMAD UMAIR RAFI,
MD
QIANG, MEI, MD
QUBTY, ROBIN , DO
P7546
N7574
N7480
QUIAMBAO, LEONILA SONGCO, MD
QUINTANILLA, ELEAZAR JR, MD
QURESHI, IRFAN RASHID, MD
RADHAKRISHNA, PAVANA , MD
RADWANSKI, SYLVIA VICTORIA,
MD
RAFEEK, JASMINE, MD
RAJABI HANJANI, MITRA, MD
P5451
RAJURKAR, SWAPNIL, MD
8/29/2008
8/2/2010
7/1/2011
Secondary Specialty
(Self-Designated)
HOSPITALIST
HOSPITALIST
5/16/2011
11/4/2011
8/1/2013
12/1/2010
11/6/2009
4/12/2013
8/1/2018
12/1/2015
11/6/2014
4/12/2018
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
HOSPITALIST
Registration
Status of
Practice
Texas
State
License
Practice City
NACOGDOCH
ES
TX
HOUSTON
ATLANTA
TX
GA
HOUSTON
TX
DALLAS
TX
DALLAS
HOUSTON
HUNTSVILLE
HOUSTON
TX
TX
TX
TX
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/10/2008 None
N/A
8/4/2010 None
8/1/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
4/2/2012 None
N/A
7/1/2010 None
3/15/2012 None
6/12/2012 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
6/9/2011 None
2/12/2009 None
11/8/2011 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
8/13/2013
12/7/2010
11/24/2009
4/22/2013
None
None
None
None
N/A
N/A
N/A
N/A
2/4/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/23/2010 None
5/21/2012 None
10/18/2010 None
N/A
N/A
N/A
2/5/2010 None
9/7/2009 None
11/11/2011 None
N/A
N/A
N/A
2/4/2011
8/2/2010
5/15/2012
9/15/2010
DALLAS
TX
2/5/2010
8/21/2009
11/4/2011
HOUSTON
TX
AUSTIN
HARLINGEN
VICTORIA
CHICAGO
TX
TX
TX
IL
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/14/2010
9/24/2008
6/12/2012
3/10/2009
None
None
None
None
N/A
N/A
N/A
N/A
SAN ANTONIO TX
HOUSTON
TX
TX
HEMATOLOGY/ONCO
2/1/2018 INTERNAL MEDICINE LOGY
POMONA
CA
Page 157 of 301
ACTIVE
ACTIVE
ACTIVE
8/9/2013 None
9/10/2010 None
8/24/2010 None
N/A
N/A
N/A
ACTIVE
2/28/2013 None
N/A
4/9/2010
4/9/2015
8/29/2008
8/29/2013
6/8/2012
6/8/2017
12/12/2008 12/12/2013
8/1/2013
8/27/2010
8/16/2010
2/1/2013
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N9768
RAMACHANDRAN, KAVAN, MD
5/16/2011
P3662
N7165
6/15/2012
7/15/2010
10/1/2010
N5350
RAMACHANDRUNI, SRIKANTH, MD
RAMASAHAYAM, LAKSHMI, MD
RAMIREZ, JONATHAN CHARLES,
MD
RAMOS, ENRIQUE CISNEROS JR,
DO
2/5/2010
N5351
RANDHAWA, SHAHID RASUL, MD
2/5/2010
P3570
P2511
RANDLE, KELLEE LORRAINE, DO
RAZA, ALI, MD
6/8/2012
3/15/2012
N4693
REDDY, ARVIND CHERKU, MD
REDDY, MEDAPALLY PRADEEP,
MD
REESE, ERIN ADAIRE, MD
REICHERT, SARAH IRENE, DO
REN, JIE, MD
11/6/2009
RICE, LEVI ANDREW JR, DO
RICE, LYNN ANN, DO
RINCON, ENRIQUE JOSE
ANTONIO, MD
RIVERA PABON, FRANCISCO
RAFAEL, MD
2/5/2010
8/15/2013
11/4/2011
6/3/2013
N7863
N8450
N8711
P6510
N9288
N5359
P7696
P1397
P6902
N6616
P6259
P3429
N9946
P5460
P3067
N9636
RIVERA, RACHEL , MD
RODRIGUEZ CASTRO, CARLOS E,
MD
RODRIGUEZ, CARMEN , MD
ROMERO, ALICIA BEATRIZ, MD
ROSARIO FELICIANO, RALPHIE
ALBERTO, MD
ROSAS, LUIS ALBERTO, MD
ROUF, EMRAN, MD
1/3/2011
2/4/2011
5/1/2013
4/1/2011
1/3/2016
2/4/2016
5/1/2018
4/1/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
6/4/2010
4/12/2013
6/1/2012
6/3/2011
2/1/2013
5/1/2012
5/2/2011
Secondary Specialty
(Self-Designated)
PULMONARY
CRITICAL CARE
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
TEMPLE
TX
CARDIOLOGY
ALLERGY AND
IMMUNOLOGY
GASTROENTEROLOG
Y
TOMBALL
TX
INTERNAL MEDICINE
HOSPITALIST
HOSPITALIST
DALLAS
HOUSTON
ST. LOUIS
TX
TX
MO
MESA
FORT SAM
HOUSTON
AZ
TX
INFECTIOUS
DISEASES
TX
NEPHROLOGY
INFECTIOUS
DISEASES
Page 158 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/16/2011 None
N/A
6/15/2012 None
7/21/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
10/11/2010 None
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
6/8/2012 None
4/26/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
2/1/2010 None
N/A
1/3/2011
2/9/2011
5/20/2013
4/11/2011
None
None
None
None
N/A
N/A
N/A
N/A
2/5/2010 None
8/20/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/14/2011 None
N/A
6/3/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/24/2013 None
N/A
6/1/2012 None
6/10/2011 None
N/A
N/A
ABILENE
TX
ACTIVE
2/7/2013 None
N/A
MCALLEN
TEMPLE
TX
TX
ACTIVE
ACTIVE
6/8/2012 None
5/4/2011 None
N/A
N/A
License
Number
Physician Name
P5884
RUAN, CHENG-HUAI, MD
RUIZ GONZALEZ, HELBERT
N4053
EDUARDO, MD
RUIZ-BARON, MAURICIO
N7168
ALEXANDER, MD
N4711
RUOFF, CHAD MICHAEL, MD
P2355
RYALI, NEELIMA DEVI R A, MD
P1586
RZEPKA, ROBERT , MD
N7338
P0287
P6909
SAEED, ALIYA, MD
SAGALLA, REX B, DO
SAHEBJAM, FARHAD, MD
P2514
SAHLOUL, ELSAYED AHMED, MD
P4705
P6072
SAIYAD, SALEEM, MD
SAJJA, NAVEEN, MD
P2516
N1122
SALEEM, SADIA , MD
SAMBATHKUMAR, LAKSHMI , MD
P5466
edicaid
edicaid
End Date
Designated)
3/15/2013
8/21/2009
7/15/2010
11/6/2009
3/1/2012
12/1/2011
8/2/2010
7/1/2011
6/3/2013
3/15/2012
Secondary Specialty
(Self-Designated)
Practice City
CONWAY
HOUSTON
INTERNAL MEDICINE ABILENE
INFECTIOUS
DISEASES
CONCORD
HEPATOLOGY
Registration
Status of
Practice
Texas
State
License
ACTIVE
AR
ACTIVE
11/18/2009 None
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/27/2010 None
11/12/2009 None
3/9/2012 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
1/30/2012 None
N/A
8/2/2010 None
7/18/2011 None
6/5/2013 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
4/12/2012 None
N/A
10/15/2012 None
4/8/2013 None
N/A
N/A
3/15/2012 None
11/6/2008 None
N/A
N/A
2/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
3/30/2011 None
N/A
8/2/2010
2/11/2011
4/27/2010
4/9/2013
None
None
None
None
N/A
N/A
N/A
N/A
7/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/11/2012 None
N/A
7/15/2010 None
10/22/2010 None
N/A
N/A
9/17/2008 None
N/A
NH
HOUSTON
TX
DALLAS
TX
4/1/2013
3/15/2012
8/29/2008
SAMEERUDDIN, SYED RAHEEL, MD
2/1/2013
N9124
SANA, MOAZZAM MOHAMMAD, DO
3/15/2011
N7339
N8454
N5996
P6074
SANCHEZ, DIANA E, MD
SANCHEZ, IRAHAM AXEL, MD
SANGANA, DINESH KUMAR, MD
SANI, SHAHRAM NOROUZI, MD
N7170
P3577
SANKA, V S SHANKAR C, MD
SANKARA, ISHWARA RAGHU
PRASHANTH, MD
N7171
N7968
SANON, SAURABH , MD
SANTOS, LAMBERT-IAN, MD
N1127
SARDINI, MUSTAFA , MD
8/2/2010
1/3/2011
4/9/2010
4/1/2013
7/15/2010
6/8/2012
8/2/2015
1/3/2016
4/9/2015
4/1/2018
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
HOSPITALIST
INTERNAL MEDICINE WASHINGTON DC
CRITICAL CARE
MEDICINE
DALLAS
HOSPITALIST
HOUSTON
TX
NACOGDOCH
ES
TX
7/15/2010
8/29/2008
Page 159 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/22/2013 None
N/A
TX
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N8144
N8241
SAWHNEY, SUMAN KUMAR, MD
SCHMIT, DAVID ROGER, MD
P0672
SCHURMANN, PAUL ANTONIO, MD
8/1/2011
N6989
N6990
N3298
SEAWELL, MICHAEL ROBERT, MD
SEHGAL, RAJ TEK, MD
SEIN, TIN , MD
7/1/2010
7/1/2010
5/29/2009
N6648
SETHI, MUNAZZA SAJJAD, MD
N5388
N3300
SHAFER, KERI MARIE, MD
SHAFI, NAHID , MD
N9643
SHAH, AJAY KUMAR, MD
P6519
N1889
SHAH, MANAN SHIRISHKUMAR, MD
SHAH, NEERAJ BHAGWAN, MD
P4820
SHAH, SHILPAN SATISH, MD
N2794
N6993
SHAH, SWATI RUCHIR, MD
SHAH, TEJAL BIPIN, MD
N6994
N4085
12/1/2010
6/4/2010
2/5/2010
5/29/2009
5/2/2011
Registration
Status of
Practice
Texas
State
License
Secondary Specialty
(Self-Designated)
Practice City
GERIATRIC
MEDICINE (INTERNAL
MED)
STONY POINT NY
SAN ANTONIO TX
HOSPITALIST
GERIATRIC
MEDICINE (INTERNAL
MED)
WACO
5/1/2013
11/1/2012
4/3/2009
7/1/2010
SHAHID, NAHEED AHMAD, MD
SHAKIL, JAWAIRIA , MD
7/1/2010
8/21/2009
K1671
P7350
SHAMAA, SHERIF MOHAMED, MD
SHARDA, ROHIT, MD
2/5/2010
7/15/2013
N9956
SHEIKH, SHAZIA SHAFEEQ, MD
6/3/2011
P0673
N4093
SHERPA, TSERING, MD
SHESHADRI, AJAY, MD
8/1/2011
8/21/2009
SAN ANTONIO TX
HOUSTON
TX
ODESSA
DALLAS
HEMATOLOGY/ONCO
LOGY
GERIATRIC
MEDICINE (INTERNAL
MED)
SAN MATEO
MIDLAND
TX
TX
TX
CA
TX
GREENSBURG IN
HOSPITALIST
DALLAS
TX
HOSPITALIST
Page 160 of 301
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/13/2010 None
12/17/2010 None
N/A
N/A
8/15/2011 None
N/A
7/1/2010 None
7/26/2010 None
8/10/2009 None
N/A
N/A
N/A
6/4/2010 None
N/A
2/5/2010 None
6/16/2009 None
N/A
N/A
5/2/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/17/2013 None
3/13/2009 None
N/A
N/A
11/1/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/29/2009 None
7/6/2010 None
N/A
N/A
7/1/2010 None
8/27/2009 None
N/A
N/A
2/5/2010 None
7/16/2013 None
N/A
N/A
6/3/2011 None
N/A
8/1/2011 None
9/7/2009 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P0137
SHIBLI, ADEEL BASIT, MD
P0932
P5726
SHINDE, ANITA BHAGWAN, MD
SHIRLEY, YOUNG SHIL, MD
N8572
N1142
N9300
N9130
edicaid
edicaid
End Date
Designated)
6/15/2011
9/1/2011
3/1/2013
SHIRVANI, SHERVIN , MD
SHOOK, RYAN SETH, MD
SHUKLA, MANAN S, MD
1/18/2011
8/29/2008
4/1/2011
3/15/2011
N6664
N2299
P2366
N8243
SIBAL, AMAN, MD
SIDDIQI, MUHAMMAD NAVEED
SALEH, MD
SIDDIQUI, REAZ MAHMOOD, MD
SIDHU, NAVNEET, MD
SIGWORTH, STEPHEN, MD
6/4/2010
2/6/2009
3/1/2012
12/1/2010
6/4/2015
2/6/2014
3/1/2017
12/1/2015
N6025
N6026
N4103
SILAT, NOOMAN YOUNUS, MD
SIM, MEESUN RACHEL, MD
SIMMONS, JASON LEVON, MD
4/9/2010
4/9/2010
8/21/2009
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
N8244
SIMS, JAMES III, MD
12/1/2010
N4753
SINGH, HITESH BHRIGUNATH, MD
11/6/2009
N6028
SINGH, LAV, MD
4/9/2010
N7658
N3313
SINGH, SUPRIYA , MD
SKLAR, LISA CARRIE, DO
9/1/2010
5/29/2009
P3244
P7571
SMITH, MELODY , MD
SMITH, NATALIE MARIE, MD
SOBAMOWO, HEZEKIAH
OLUWAROTIMI, MD
SOLIPURAM, ARUN KUMAR REDDY
, MD
SOLTERO REYES, LILIANA , MD
SOMASUNDARAVELAYUDHAM,
SUDHA THANGAM, MD
5/15/2012
8/1/2013
12/1/2011
P1595
N4120
N4764
N1156
Secondary Specialty
(Self-Designated)
PULMONARY
CRITICAL CARE
MEDICINE
HOSPITALIST
RADIATION
ONCOLOGY
HOSPITALIST
Practice City
Registration
Status of
Practice
Texas
State
License
MESQUITE
TX
EL PASO
TX
HOUSTON
TX
PHOENIX
AZ
HOUSTON
TYLER
HOUSTON
DALLAS
TX
TX
TX
TX
INFECTIOUS
DISEASES
ONCOLOGY
INFECTIOUS
DISEASES
PULMONARY
CRITICAL CARE
MEDICINE
8/29/2008
Page 161 of 301
ACTIVE
LICENSE
ISSUED
ACTIVE
6/20/2011 None
N/A
9/1/2011 None
3/4/2013 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
1/27/2011 None
10/13/2008 None
4/6/2011 None
N/A
N/A
N/A
3/15/2011 None
N/A
6/4/2010
4/3/2009
3/5/2012
12/8/2010
None
None
None
None
N/A
N/A
N/A
N/A
4/9/2010 None
5/3/2010 None
11/13/2009 None
N/A
N/A
N/A
ACTIVE
12/21/2010 None
N/A
TX
ACTIVE
12/11/2009 None
N/A
PARIS
TX
ACTIVE
4/15/2010 None
N/A
TEMPLE
TX
9/14/2010 None
6/24/2009 None
N/A
N/A
DALLAS
NEW
ORLEANS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
5/15/2012 None
8/5/2013 None
N/A
N/A
LA
ACTIVE
2/6/2012 None
N/A
OR
TX
ACTIVE
ACTIVE
9/21/2009 None
12/21/2009 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
9/18/2008 None
N/A
GERIATRICS INTERNAL MEDICINE SALEM
NEPHROLOGY
HOUSTO
Disciplinary
Status Date
TEMPLE
HEMATOLOGY/ONCO
LOGY
8/21/2009
11/6/2009
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
N8064
P0675
N7970
P6527
N6677
Physician Name
SOROLLA-OLYMPIA, MARICELLE
GOINGCO, MD
SOSA PEREZ, SUALY , MD
SOSA, ISMAEL TRES, MD
SPATH, FUAD ANTONIO, MD
9/15/2011
6/15/2012
N6683
STEANS, MARIA CECILIA, MD
STEARNS, CHRISTOPHER ALAN,
MD
6/4/2010
N8577
P1932
P7576
STEEL, RICHARD JOSEPH, MD
STEFFER, KAREN JUNE, MD
STEVENER, DAVID SCOTT, MD
1/18/2011
1/17/2012
8/1/2013
E6635
N3332
P6531
STOCKMAN, GAIL DIANE, MD
STREAM, AMANDA RAE, MD
SUBNANI, KISHORE RAJ, MD
N7753
P2376
P0302
P0678
SUGUMARAN, RAMASAMY T, MD
SULEIMAN, EHAB SAID ABDEL
AZIZ, MD
SULEIMAN, YOUSEF NABIL, MD
SUNDERAJAN, KIRTANA , MD
P3459
SUTHERLUN, LYDIA ANN, MD
P3672
P0143
SUTTON, SHELBY ELIZABETH, MD
P4719
N4773
SWALDEK, GNIEWOMIRA, MD
SWARR, PETER JAMES, MD
P5740
SYAMALA, SHIRMILA, MD
Secondary Specialty
(Self-Designated)
8/1/2011
5/1/2013
6/4/2010
P1025
SPRINGSTON, CHRISTA RENE, MD
STAFFORD, REBECCA ELIZABETH,
MD
edicaid
edicaid
End Date
Designated)
5/29/2009
5/1/2013
HOSPITALIST
PALLIATIVE
MEDICINE
PULMONARY
MEDICINE
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
ACTIVE
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
EL PASO
TX
ACTIVE
EL PASO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
P3254
SYED, WAQAR, MD
5/15/2012
6/19/2012 None
N/A
6/4/2010 None
N/A
1/18/2011 None
1/25/2012 None
8/2/2013 None
N/A
N/A
N/A
HUBER
HEIGHTS
OH
ACTIVE
9/20/2010 None
N/A
OK
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
3/12/2012 None
7/11/2011 None
8/22/2011 None
N/A
N/A
N/A
6/1/2012 None
N/A
6/15/2011 None
N/A
11/5/2012 None
11/19/2009 None
N/A
N/A
3/1/2013 None
N/A
HOSPITALIST
PULMONARY
CRITICAL CARE
MEDICINE
1/18/2011
N/A
N/A
N/A
N/A
SYED, ASIF SULTAN, MD
10/24/2011 None
11/20/2012 None
6/12/2009 None
5/15/2013 None
6/1/2012
N8581
N/A
ACTIVE
ACTIVE
ACTIVE
VASCULAR MEDICINE MCALESTER
WACO
DALLAS
3/1/2013
6/4/2010 None
TX
PEDIATRICS
N/A
N/A
N/A
N/A
CORSICANA
3/1/2012
7/1/2011
8/1/2011
11/6/2009
None
None
None
None
TX
TX
10/29/2010
9/6/2011
10/22/2010
7/2/2013
Disciplinary
Status Date
DALLAS
CORSICANA
9/15/2010
6/15/2011
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
PHILADELPHIA PA
BRENTWOOD TN
GERIATRICS 1/18/2016 INTERNAL MEDICINE INTERNAL MEDICINE ATLANTA
EMERGENCY
5/15/2017 INTERNAL MEDICINE MEDICINE
RULEVILLE
Page 162 of 301
ACTIVE
ACTIVE
LICENSE
ISSUED
GA
ACTIVE
2/14/2011 None
N/A
MS
ACTIVE
6/4/2012 None
N/A
6/3/2013
11/6/2009
TANG, ZHOUWEN , MD
TARAKJI, MUHAMMAD ANAS, MD
6/1/2012
2/6/2009
4/1/2011
1/2/2012
N7356
P6928
TAYLOR, LAKEYSHA, MD
TE, TAM THI DUC, MD
TEEGAVARAPU, PURNIMA
SRAVANTI, MD
TENG, STEFANIE AMY, MD
Registration
Status of
Practice
Texas
Practice City
State
License
FORT WORTH TX
ACTIVE
HOUSTON
TX
ACTIVE
PARIS
IL
ACTIVE
LICENSE
ISSUED
WATAUGA
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
AUSTIN
TX
ACTIVE
8/2/2010
6/3/2013
HOUSTON
AUSTIN
TX
TX
P3258
TERASAKI, ORELIA RAMIREZ, MD
5/15/2012
TEXAS CITY
KILLEEN
MONAHANS
HOUSTON
License
Number
Physician Name
P5482
SZERLIP, HAROLD MICHAEL, MD
N8464
TADROS, EIRINY , MD
P1236
TAKKALLAPALLI, SRINU, MD
P6925
N4782
TAN, ALVIN RAYMOND CO, MD
TAN, YUE-QING , MD
P3461
N2312
N9314
P1826
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
2/1/2013
2/1/2018 INTERNAL MEDICINE NEPHROLOGY
1/3/2011
P1700
P0679
N4795
P3464
TEWARI, SHALINI, MD
THATIKONDA, CHANDANA, MD
THAUNG, HTIN AUNG, MD
THOMAS MOHAN, REENA , MD
P1601
N9141
P3259
P2795
P6098
P1701
THOMAS, ABEY KOZHIMANNIL, MD
THOMAS, SANDHYA SARA, MD
THOMAS, SIBI PHILIPOSE, DO
THOMAS, STEPHANIE, MD
THURMAN, JERRY LEE JR, MD
TINIO, FREDERICK GUTIERREZ,
MD
TISCARENO-GRAJEDA, LETICIA
ILIANA, MD
N9785
TOMOYE, EDWARD O, DO
5/16/2011
N7886
TOTOE, ROBERT ASAMOAH, MD
10/1/2010
P2799
N7504
TRAN, KY DIEU, MD
TRANG, TONY , MD
4/2/2012
8/16/2010
N7885
8/1/2011
11/6/2009
6/1/2012
12/1/2011
3/15/2011
5/15/2012
4/2/2012
4/1/2013
12/1/2016
3/15/2016
5/15/2017
4/2/2017
4/1/2018
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
10/1/2010
NEPHROLOGY
HOSPITALIST
6/3/2013 None
1/24/2010 None
N/A
N/A
6/1/2012 None
2/13/2009 None
N/A
N/A
4/1/2011 None
2/13/2012 None
N/A
N/A
ACTIVE
ACTIVE
8/5/2010 None
6/20/2013 None
N/A
N/A
TX
ACTIVE
5/17/2012 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
1/2/2012
8/5/2011
11/19/2009
6/27/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
12/12/2011
3/23/2011
5/25/2012
4/19/2012
4/29/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
10/1/2010 None
N/A
TX
ACTIVE
12/20/2011 None
N/A
6/17/2011 None
N/A
10/1/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
4/2/2012 None
8/26/2010 None
N/A
N/A
GERIATRIC
MEDICINE (INTERNAL
MED)
NEPHROLOGY
NEPHROLOGY
HOUSTON
TX
FORT WORTH TX
HOUSTON
HOSPITALIST
INFECTIOUS
DISEASES
Page 163 of 301
EL PASO
HOUSTON
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
2/13/2013 None
N/A
1/26/2011 None
N/A
11/14/2011 None
N/A
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P5487
TRICINELLA, LINDSEY TANNER, DO
N6723
P5900
P0801
P0508
TRIFUNOVIC, BORIVOJE, MD
TRUONG, PHU THIEN, DO
TRUONG, TAM MINH, MD
TUMMALA, JAGDISH, MD
6/4/2010
3/15/2013
8/15/2011
7/15/2011
N9657
P3600
TUMYAN, ANNA, MD
TURNER, BARBARA JEAN, MD
5/2/2011
6/8/2012
N6733
N2326
2/1/2013
6/4/2015
3/15/2018
8/15/2016
7/15/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
P2801
P7222
N1932
N1194
P2073
P0884
VADYALA, VIKRAM REDDY, MD
VALDES, PAVEL , MD
2/1/2012
8/26/2011
N6741
P1603
VALENTIN, REUBEN JR, MD
VALLABHAJOSULA, SAILAJA, MD
6/4/2010
12/1/2011
P5754
N9660
VARIA, APURV KIRIT, MD
VARUGHESE, ROY , MD
3/1/2013
5/2/2011
N5452
P6103
VASALLO, JAVIER ALEJANDRO, MD
VASANTH, PAYASWINI , MD
2/5/2010
4/1/2013
N5455
VAYANI, RADHIKA , DO
2/5/2010
VEDAVALLI, ABHISHEK, MD
P3092
VEGESNA, VISWANADH RAJU, MD
N2867
VEGI, SRIVALLI , MD
4/2/2012
7/1/2013
8/29/2008
Practice City
TX
FORT WORTH TX
HOSPITALIST
HOUSTON
TYAGI, ASHOK KUMAR, DO
UDDIN, FATEMA SULTANA, MD
UGBARUGBA, EMMANUEL
EZIKERU, MD
UHEGWU, LINDA NWAOMA, MD
UMBER, AFIA , MD
UY, CESAR CHUA JR, MD
P6293
6/4/2010
2/6/2009
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
SAN ANTONIO TX
PULMONARY
CRITICAL CARE
MEDICINE
DALLAS
HOSPITALIST
HOSPITALIST
HOSPITALIST
TX
FORT WORTH TX
PALESTINE
TX
SAN ANTONIO TX
NEPHROLOGY
GASTROENTEROLOG
Y
PULMONARY
CRITICAL CARE
MEDICINE
4/12/2013
5/1/2012
4/3/2009
GERIATRIC
MEDICINE (INTERNAL
4/3/2014 INTERNAL MEDICINE MED)
Page 164 of 301
HOUSTON
TX
AUSTIN
TX
CHICAGO
IL
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/18/2013 None
N/A
6/4/2010
3/21/2013
8/18/2011
7/20/2011
None
None
None
None
N/A
N/A
N/A
N/A
5/2/2011 None
6/19/2012 None
N/A
N/A
6/4/2010 None
2/17/2009 None
N/A
N/A
None
None
None
None
N/A
N/A
N/A
N/A
2/1/2012 None
9/6/2011 None
N/A
N/A
6/4/2010 None
12/28/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/18/2013 None
5/12/2011 None
N/A
N/A
2/5/2010 None
4/5/2013 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/22/2013 None
N/A
5/1/2012 None
N/A
5/4/2009 None
N/A
ACTIVE
4/2/2012
7/26/2013
12/19/2008
9/9/2008
License
Number
Physician Name
P7721
VELAGA, RAHUL, MD
VELAMURI, NARASIMHESWARA
P2078
SARMA, MD
P6543
VELASQUEZ, ALEX HERNAN, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
8/15/2013
2/1/2012
5/1/2013
Registration
Status of
Practice
Texas
Practice City
State
License
MINNEAPOLIS MN
ACTIVE
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
2/14/2012 None
5/6/2013 None
N/A
N/A
2/5/2010 None
N/A
6/4/2010 None
12/7/2010 None
N/A
N/A
7/1/2010 None
12/6/2010 None
N/A
N/A
4/2/2012 None
8/18/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
6/15/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
9/6/2013 None
N/A
ACTIVE
ACTIVE
11/16/2009 None
1/24/2012 None
N/A
N/A
SHREVEPORT LA
ACTIVE
ACTIVE
8/18/2011 None
1/3/2012 None
N/A
N/A
HOUSTON
HOUSTON
GALVESTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
REDMOND
DALLAS
OR
TX
ACTIVE
ACTIVE
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
N5459
VEMURI, SRINATH SARMA, MD
2/5/2010
N6751
N8255
VERMA, DIVYA RATAN , MD
VERNON, KIMBERLY ANN, MD
6/4/2010
12/1/2010
HOUSTON
TX
N7018
N8256
7/1/2010
12/1/2010
DALLAS
TX
P2806
P0807
VICKERY, ROBERTA LUCILLE, MD
VIJAYAN, SOUMIA , MD
VIZCARRA-FALLA, LUIS RAFAEL,
MD
VUPPALI, KALPANA , MD
4/2/2012
8/15/2011
CEDAR PARK
TX
N3382
WANG, JANET LUYU, MD
5/29/2009
N5469
WANG, JENNIFER , MD
2/5/2010
P7868
N4836
P1947
P0808
P1712
N7026
N7027
P1247
P2399
N7031
N4202
WANG, WEI, MD
WARMINSKI, JOHNATHAN DAVID,
MD
WEISBERG, MARK JORDAN, MD
WELLIKOFF, ADAM S, MD
WEPRICH, DEVON JOY, DO
WERAGODA, RAMAL MAJINTHA,
MD
WESLEY, ROBBY GEORGE, DO
WHITE, GREGORY RYAN, MD
WHITNEY, ERIN AHRENS, MD
WICKRAMASINGHE, ASHTON
SENATHI, MD
WILEY, CHERESE MARIE, MD
P0320
WILKE, LESLIE DAWN, DO
P7871
WOLDEYES, LIBAY, MD
HEMATOLOGY/ONCO
LOGY
HEMATOLOGY/ONCO
LOGY
8/30/2013
FAMILY MEDICINE
11/6/2009
1/17/2012
OPHTHALMOLOGY
8/15/2011
PULMONARY
CRITICAL CARE
MEDICINE
7/1/2010
7/1/2010
3/1/2012
7/1/2010
8/21/2009
7/1/2011
8/30/2013
PULMONARY
CRITICAL CARE
MEDICINE
Page 165 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/30/2013 None
N/A
LAKE
CHARLES
LA
7/14/2010
7/14/2010
11/14/2011
3/26/2012
None
None
None
None
N/A
N/A
N/A
N/A
7/14/2010 None
9/21/2009 None
N/A
N/A
7/7/2011 None
N/A
8/30/2013 None
N/A
License
Number
Physician Name
N1496
WOOD, ADAM SCOTT, MD
N3390
WOOD, FRANCES OLIVER, MD
P6554
WU, JENNIFER QI, MD
P7052
WYSOCKI, CHRISTIAN ALLEN, MD
N5493
XIE, CHUN , MD
P7371
P1033
P6115
P4531
edicaid
edicaid
End Date
Designated)
5/29/2009
5/1/2013
6/14/2013
2/5/2010
7/15/2013
9/15/2011
4/1/2013
9/17/2012
7/15/2018
9/15/2016
4/1/2018
9/17/2017
1/18/2011
P6751
N8598
XINTAVELONIS, ELENA , MD
XU, RISHENG , DO
YAFT, JOHN WAGDY, MD
YAGHMAIE, MEHRAN, MD
YALAMANCHI, LAKSHMANA RAO,
MD
YALAMANCHILI, BINDU BHARGAVI,
MD
YANG, HUA, MD
5/15/2013
1/18/2011
N9664
N2890
N8474
N7376
P0522
YAO, YUMEI, MD
YARBROUGH, SHANNON , MD
YAU, RAYMOND M, MD
YEDLAPALLI, LATHA, MD
YEMME, SOUMYA, MD
5/2/2011
4/3/2009
1/3/2011
8/2/2010
7/15/2011
5/2/2016
4/3/2014
1/3/2016
8/2/2015
7/15/2016
P4626
P6558
YEPEZ GUEVARA, EDUARDO, MD
YIP-DAVILA, DAVID K, MD
10/1/2012
5/1/2013
N8597
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
Secondary Specialty
(Self-Designated)
ALLERGY AND
IMMUNOLOGY
Practice City
TEMPLE
DALLAS
CEDAR PARK
DALLAS
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
TX
ACTIVE
LICENSE
TX
ISSUED
LICENSE
TX
ISSUED
INTERNAL MED PREV MED
HOSPITALIST
HOUSTON
DALLAS
TX
TX
INTERNAL MEDICINE PHILADELPHIA PA
DALLAS
INTERNAL MEDICINE SHREVEPORT
LUBBOCK
CARDIOLOGY
HOUSTON
HOSPITALIST
SUNNYVALE
ADDISON
NEW YORK
GERIATRIC
MEDICINE (INTERNAL
MED)
CHICAGO
8/5/2013
10/3/2011
4/11/2013
9/18/2012
None
None
None
None
N/A
N/A
N/A
N/A
5/15/2013 None
1/25/2011 None
N/A
N/A
LA
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
5/6/2011
5/14/2009
1/25/2011
8/17/2010
7/21/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
NY
ACTIVE
ACTIVE
11/1/2012 None
5/9/2013 None
N/A
N/A
IL
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
9/24/2012 None
N/A
4/9/2010 None
4/2/2012 None
N/A
N/A
3/1/2012 None
8/20/2013 None
N/A
N/A
10/29/2010 None
N/A
6/12/2012 None
N/A
7/15/2010 None
N/A
N6115
P2562
YOOSEFIAN, FARIDA , MD
YOUNUS, SIDRA , MD
4/9/2010
3/15/2012
AUSTIN
TX
P2406
P7730
YOUSUF, SHUJA, MD
YU, MICHAEL Z, MD
3/1/2012
8/15/2013
HOUSTON
TX
N8072
YUSUF, HARAR , MD
P3493
ZACHARIAH, AMIT ABRAHAM, MD
N7193
ZAHEER, IRUM, MD
Page 166 of 301
N/A
TX
7/15/2010
2/5/2010 None
N/A
9/17/2012
N/A
2/7/2011 None
YOO, JI WON, MD
6/1/2012
6/14/2013 None
ACTIVE
LICENSE
ISSUED
ACTIVE
P4533
ACTIVE
ACTIVE
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/11/2008 None
N/A
6/8/2009 None
N/A
5/6/2013 None
N/A
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
N7379
ZAHID, KANWAL, MD
N1236
edicaid
edicaid
End Date
Designated)
8/2/2010
8/29/2008
6/4/2010
P7874
P1035
ZAIDI, SYED , MD
ZALAVARRIA, JONARD HERBIAS,
MD
ZAPATA ANTIGONI, CARLOS
FERNANDO, MD
ZEINEDDINE, SALAM, MD
8/30/2013
9/15/2011
N4867
ZHAN, MAOCHENG , MD
11/6/2009
N6791
N4226
P3106
P0688
ZHAO, GUANGQUAN , MD
ZIMILEVICH, ALEXANDER, MD
ZINDANI, SHIREEN, MD
8/21/2009
5/1/2012
8/1/2011
N8751
AGUSALA, PRATAP, MD
2/15/2011
P3502
AMMAR, RICHARD FREDERICK JR,
MD
6/8/2012
P5258
AZPURUA, FEDERICO EMILIO, MD
1/15/2013
N3477
BARKER, COLIN MACLEOD , MD
8/21/2009
N4295
BHATT, NAYAN KUMAR, MD
11/6/2009
N2977
CANTOR, MICHAEL DAN, DO
5/29/2009
N1305
DIAZ SANTANA, PEDRO , MD
10/10/2008
P0720
DIM, UZODINMA RAPHAEL, MD
8/15/2011
N5669
EMERICK, ROBERT SCOTT, MD
4/9/2010
N6312
GILANI, SYED ABBAS RAZA, MD
6/4/2010
G3936
HART, TIMOTHY THOMAS, MD
8/29/2008
P6181
HERNANDEZ, ENRIQUE, MD
4/12/2013
INTERVENTIONAL
INTERVENTIONAL
6/8/2017 CARDIOLOGY
INTERVENTIONAL
INTERVENTIONAL
INTERVENTIONAL
INTERVENTIONAL
INTERVENTIONAL
INTERVENTIONAL
INTERVENTIONAL
4/9/2015 CARDIOLOGY
INTERVENTIONAL
6/4/2015 CARDIOLOGY
INTERVENTIONAL
INTERVENTIONAL
Secondary Specialty
(Self-Designated)
NEPHROLOGY
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
Practice City
TYLER
THE
WOODLANDS TX
GASTROENTEROLOG
Y
LONGVIEW
LAKE
CHARLES
HEMATOLOGY/ONCO
LOGY
DALLAS
HOSPITALIST
INTERNAL MEDICINE
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
IOWA CITY
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/5/2010 None
N/A
9/8/2008 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
ACTIVE
9/9/2013 None
9/26/2011 None
N/A
N/A
LA
ACTIVE
1/6/2010 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/2/2009 None
5/4/2012 None
8/5/2011 None
N/A
N/A
N/A
2/15/2011 None
N/A
ACTIVE
6/12/2012 None
N/A
ACTIVE
1/28/2013 None
N/A
ACTIVE
8/27/2009 None
N/A
ACTIVE
12/14/2009 None
N/A
IA
INTERNAL MEDICINE
CARDIOVASCULAR
DISEASES
HOUSTON
CARDIOVASCULAR
DISEASES
TX
CARDIOLOGY
TEXARKANA
TX
ACTIVE
6/15/2009 None
N/A
CARDIOLOGY
CARDIAC
ELECTROPHYSIOLO
GY
LAREDO
TX
ACTIVE
11/7/2008 None
N/A
EL PASO
TX
8/15/2011 None
N/A
4/9/2010 None
N/A
6/4/2010 None
N/A
CARDIOLOGY
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
CARDIOVASCULAR
DISEASES
Page 167 of 301
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
DES MOINES
IA
ACTIVE
9/10/2008 None
N/A
NEW YORK
NY
ACTIVE
4/30/2013 None
N/A
License
Number
Physician Name
P3191
LIN, CHUN HUIE, MD
N3159
MALIK, JAMIL AYUB, MD
N8544
N2657
MATHEW, SALIM BENJAMIN, MD
MENDEZ-MARTINEZ, JOSE
IGNACIO, MD
N8325
MIRZA, RUBINA ASIF, MD
P4487
MOOSA, YUNUS, MD
P4685
NASUR, ALI MOHAMED, MD
P0114
PATINO, GILBERTO , MD
P3060
PHAM, SON VAN, MD
P6700
P4999
POLKAMPALLY, PRITAM RAO, MD
REINSVOLD, THOMAS MICHAEL,
MD
P2349
REYES, MANUEL MUNOZ, MD
P1020
SECH, CANDICE KAY, MD
P0791
SHAH, UMANG HASMUKHLAL, MD
P4911
SZERLIP, MOLLY, MD
N4812
P0154
TURER, ASLAN TEYFIK, MD
YAMANI, HUSSEIN NOORUDDIN,
MD
N9497
ADLER, GRIT ARMSTRONG, MD
H7918
BOWERS, HAL GREGORY JR, MD
P4951
FOX, WILLIAM CORY, MD
edicaid
edicaid
End Date
Designated)
INTERVENTIONAL
5/15/2012
INTERVENTIONAL
5/29/2009
INTERVENTIONAL
1/18/2011
INTERVENTIONAL
4/3/2009
4/3/2014 CARDIOLOGY
INTERVENTIONAL
12/15/2010 12/15/2015 CARDIOLOGY
INTERVENTIONAL
9/17/2012
INTERVENTIONAL
10/15/2012 10/15/2017 CARDIOLOGY
INTERVENTIONAL
6/15/2011
INTERVENTIONAL
5/1/2012
5/1/2017 CARDIOLOGY
INTERVENTIONAL
5/15/2013
INTERVENTIONAL
11/30/2012 11/30/2017 CARDIOLOGY
INTERVENTIONAL
3/1/2012
3/1/2017 CARDIOLOGY
INTERVENTIONAL
9/15/2011
INTERVENTIONAL
8/15/2011
INTERVENTIONAL
11/15/2012 11/15/2017 CARDIOLOGY
INTERVENTIONAL
11/6/2009
INTERVENTIONAL
6/15/2011
INTERVENTIONAL
5/2/2011
5/2/2016 RADIOLOGY
INTERVENTIONAL
1/2/2012
1/2/2017 RADIOLOGY
INTERVENTIONAL
11/30/2012 11/30/2017 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
CARDIOLOGY
CARDIOVASCULAR
DISEASES
HOUSTON
FORT SAM
HOUSTON
TX
ACTIVE
5/17/2012 None
N/A
TX
ACTIVE
6/16/2009 None
N/A
CARDIOLOGY
CARDIOVASCULAR
DISEASES
EL PASO
TX
ACTIVE
1/27/2011 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
4/16/2009 None
N/A
12/15/2010 None
N/A
9/21/2012 None
N/A
10/25/2012 None
N/A
6/15/2011 None
N/A
5/3/2012 None
N/A
6/11/2013 None
N/A
11/30/2012 None
N/A
CARDIOLOGY
CARDIOVASCULAR
DISEASES
ELECTROPHYSIOLO
GY
ZACHARY
LA
INTERNAL MEDICINE
CARDIOVASCULAR
DISEASES
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
ACTIVE
CARDIOLOGY
CARDIOVASCULAR
DISEASES
LAKEWAY
CARDIOLOGY
HOUSTON
TX
ACTIVE
3/5/2012 None
N/A
CARDIOLOGY
PLANO
TX
ACTIVE
9/21/2011 None
N/A
CARDIOLOGY
SAN ANTONIO TX
ACTIVE
8/22/2011 None
N/A
CARDIOLOGY
TUCSON
AZ
ACTIVE
11/19/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
11/16/2009 None
N/A
6/15/2011 None
N/A
TX
ACTIVE
CARDIOLOGY
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
Page 168 of 301
ACTIVE
LICENSE
ISSUED
BEEVILLE
TX
ACTIVE
5/9/2011 None
N/A
PRESCOTT
AZ
ACTIVE
1/4/2012 None
N/A
SUGARLAND
TX
ACTIVE
12/5/2012 None
N/A
License
Number
P5364
Physician Name
P2648
FREDIEU, ANDRE, MD
GARZA BERLANGA, ANDRES
EUGENIO, MD
P0055
GOEI, ANTHONY DHIANTIE, MD
N5694
GREGG, JAMES PARKER SR, MD
P0230
HUANG, STEVEN, MD
P1337
JOSEPH, ALLEN, MD
KUKREJA, KAMLESH
UTTAMCHAND, MD
P7793
P0632
N1760
P3657
MANDAVA, ANEEL, MD
MCGUCKIN, JAMES FREDERICK
JR, MD
N8137
NOURANIFAR, RABIN, MD
PIMPALWAR, SHEENA ASHWIN,
MD
P0654
POLEY, RAINER NIKOLAUS, MD
P5463
SABIR, SHARJEEL , MD
P4906
SATTAR, AMBREEN, MD
P7594
WEST, DEREK LAMONT, MD
P6779
BALLAS, JERASIMOS, MD
N4301
P1969
BLACKWELL, SEAN CYLE, MD
BOTTALICO, JOSEPH NICHOLAS,
DO
N2965
BRUNER, JOSEPH PAUL, MD
N5598
BURTON, AIYANNA, MD
edicaid
edicaid
End Date
Designated)
INTERVENTIONAL
2/1/2013
2/1/2018 RADIOLOGY
INTERVENTIONAL
4/2/2012
4/2/2017 RADIOLOGY
INTERVENTIONAL
6/15/2011
6/15/2016 RADIOLOGY
INTERVENTIONAL
4/9/2010
4/9/2015 RADIOLOGY
INTERVENTIONAL
7/1/2011
7/1/2016 RADIOLOGY
INTERVENTIONAL
11/4/2011
11/4/2016 RADIOLOGY
INTERVENTIONAL
8/30/2013
8/30/2018 RADIOLOGY
INTERVENTIONAL
8/1/2011
8/1/2016 RADIOLOGY
INTERVENTIONAL
12/12/2008 12/12/2013 RADIOLOGY
INTERVENTIONAL
6/15/2012
6/15/2017 RADIOLOGY
INTERVENTIONAL
11/15/2010 11/15/2015 RADIOLOGY
INTERVENTIONAL
8/1/2011
8/1/2016 RADIOLOGY
INTERVENTIONAL
2/1/2013
2/1/2018 RADIOLOGY
INTERVENTIONAL
11/15/2012 11/15/2017 RADIOLOGY
INTERVENTIONAL
8/1/2013
8/1/2018 RADIOLOGY
MATERNAL AND
6/3/2013
6/3/2018 FETAL MEDICINE
MATERNAL AND
11/6/2009
MATERNAL AND
2/1/2012
MATERNAL AND
5/29/2009
MATERNAL AND
4/9/2010
Secondary Specialty
(Self-Designated)
NEUROLOGY
Practice City
PLANO
Registration
Status of
Practice
Texas
State
License
TX
SAN ANTONIO TX
RADIOLOGY
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
PEDIATRIC
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS
OBSTETRICS
Page 169 of 301
Disciplinary
Status Date
ACTIVE
2/21/2013 None
N/A
ACTIVE
LICENSE
ISSUED
4/12/2012 None
N/A
6/15/2011 None
N/A
ACTIVE
4/30/2010 None
N/A
7/18/2011 None
N/A
HOUSTON
TX
ACTIVE
SAN JOSE
CA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/15/2011 None
N/A
8/30/2013 None
N/A
8/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/28/2009 None
N/A
6/15/2012 None
N/A
DIAGNOSTIC
RADIOLOGY
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
ACTIVE
12/8/2010 None
N/A
AUSTIN
TX
ACTIVE
8/15/2011 None
N/A
HOUSTON
TX
ACTIVE
2/4/2013 None
N/A
DETROIT
MI
ACTIVE
11/26/2012 None
N/A
HOUSTON
TX
ACTIVE
8/16/2013 None
N/A
HOUSTON
TX
ACTIVE
7/1/2013 None
N/A
HOUSTON
TX
ACTIVE
11/13/2009 None
N/A
ODESSA
TX
ACTIVE
2/10/2012 None
N/A
ODESSA
TX
ACTIVE
6/3/2009 None
N/A
ACTIVE
4/14/2010 None
N/A
License
Number
P0560
Physician Name
CARVER, ALISSA RENEE, MD
P7763
FAUSETT, MERLIN BARDETT, MD
N2517
P5807
GANDHI, MANISHA , MD
GIANOPOULOS, JOHN GEORGE,
MD
P0054
GIDVANI, MONISHA PARVIN, MD
P0595
HAERI, SINA , MD
N9379
IYER, CHITRA, MD
P0085
LODEIRO, JORGE GABRIEL, MD
N9601
MCDONNOLD, MOLLIE ANN, MD
H4840
MEYER, BRUCE ALAN, MD
N4680
PREDANIC, MLADEN, MD
RICHARDSON, ALVIE CLIFFORD,
MD
MD
MD
L6157
L6157
L6157
N3376
N1567
P1153
VISINTINE, JOHN FRANCIS III, MD
BRUNETTI-PIERRI, NICOLA , MD
WISZNIEWSKI, WOJCIECH
KRZYSZTOF, MD
P0461
OSAMA, FAUZIA KHALIDA, MD
P6381
EGGLESTON, JOHN MORTON III,
MD
edicaid
edicaid
End Date
Designated)
MATERNAL AND
8/1/2011
MATERNAL AND
8/30/2013
MATERNAL AND
4/3/2009
MATERNAL AND
3/15/2013
MATERNAL AND
6/15/2011
MATERNAL AND
8/1/2011
MATERNAL AND
4/8/2011
MATERNAL AND
6/15/2011
MATERNAL AND
5/2/2011
6/4/2010
6/4/2015
11/6/2009
11/6/2014
12/17/2012 12/17/2017
12/17/2012 12/17/2017
12/17/2012 12/17/2017
5/29/2009
5/29/2014
12/12/2008 12/12/2013
10/3/2011
7/15/2011
5/1/2013
MATERNAL AND
FETAL MEDICINE
MATERNAL AND
FETAL MEDICINE
MATERNAL AND
FETAL MEDICINE
MATERNAL AND
FETAL MEDICINE
MATERNAL AND
FETAL MEDICINE
MATERNAL AND
FETAL MEDICINE
MEDICAL GENETICS
Secondary Specialty
(Self-Designated)
GALVESTON
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
TX
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
PLASTIC &
RECONSTRUCTIVE
SURGERY
Page 170 of 301
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/10/2011 None
N/A
8/30/2013 None
N/A
HOUSTON
TX
ACTIVE
5/5/2009 None
N/A
AUSTIN
TX
ACTIVE
3/19/2013 None
N/A
DALLAS
TX
ACTIVE
6/20/2011 None
N/A
HOUSTON
TX
ACTIVE
8/5/2011 None
N/A
BOSTON
MA
4/26/2011 None
N/A
6/15/2011 None
N/A
5/2/2011 None
N/A
KANSAS CITY MO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
6/4/2010 None
N/A
DALLAS
TX
ACTIVE
11/11/2009 None
N/A
AUSTIN
TX
ACTIVE
12/26/2012 None
N/A
AUSTIN
TX
ACTIVE
12/26/2012 None
N/A
AUSTIN
CORPUS
CHRISTI
HOUSTON
TX
ACTIVE
12/26/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
6/22/2009 None
12/17/2008 None
N/A
N/A
HOUSTON
TX
ACTIVE
11/1/2011 None
N/A
LICENSE
ISSUED
7/15/2011 None
N/A
5/7/2013 None
N/A
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
10/3/2016 MEDICAL GENETICS
MEDICAL
TOXICOLOGY
(EMERGENCY
7/15/2016 MEDICINE)
5/1/2018 MICROSURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
AUSTIN
TX
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
MOHS
MICROGRAPHIC
4/1/2013
4/1/2018 SURGERY
MOHS
MICROGRAPHIC
9/15/2010
9/15/2015 SURGERY
MUSCULOSKELETAL
5/2/2011
5/2/2016 ONCOLOGY
Secondary Specialty
(Self-Designated)
DERMATOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
THE
WOODLANDS TX
P5987
HARTING, MANDY S, MD
N7751
STEINMAN, HOWARD , MD
N9624
RAJANI, RAJIV, MD
N8601
ADAMS, JIMMY GLENN, DO
2/4/2011
NEONATAL2/4/2016 PERINATAL MEDICINE PEDIATRICS
LICENSE
ISSUED
N8602
ADZOTOR, KWASI, MD
2/4/2011
NEONATALNEUROMUSCULAR
2/4/2016 PERINATAL MEDICINE DISEASE
L3228
AMJAD, RAMAK RAYMOND, MD
2/5/2010
NEONATAL2/5/2015 PERINATAL MEDICINE
N1533
ARNOLD, JENNIFER LYNN, MD
P6349
BYUN, YOUNG SUP, MD
N3557
CHI, ANNIE YI-AN , MD
8/21/2009
P5949
COLLADO, CARLA, MD
4/1/2013
4/2/2012
DERMATOLOGIC
SURGERY
ORTHOPEDIC
SURGERY
TX
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
4/8/2013 None
N/A
9/22/2010 None
N/A
5/2/2011 None
N/A
2/4/2011 None
N/A
2/4/2011 None
N/A
2/5/2010 None
N/A
PLANO
TX
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
1/26/2009 None
N/A
FORT WORTH TX
ACTIVE
5/9/2013 None
N/A
FORT WORTH TX
ACTIVE
8/27/2009 None
N/A
HOUSTON
TX
ACTIVE
4/4/2013 None
N/A
NEONATAL4/2/2017 PERINATAL MEDICINE NEONATOLOGY
DALLAS
TX
ACTIVE
4/9/2012 None
N/A
NEONATAL12/12/2008 12/12/2013 PERINATAL MEDICINE PEDIATRICS
5/1/2013
TEMPLE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
P2643
FRANKFURT, JOSHUA AARON, MD
P0072
KAPADIA, VISHAL S, MD
6/15/2011
DALLAS
TX
ACTIVE
6/21/2011 None
N/A
N7556
LARRAZOLO, OSCAR GABRIEL, MD
8/27/2010
HOUSTON
TX
ACTIVE
9/7/2010 None
N/A
N6449
LASEGE, TAMIKA BRANDON, MD
LICENSE
ISSUED
6/4/2010 None
N/A
6/4/2010
Page 171 of 301
License
Number
Physician Name
N9896
LOGAN, JOHN WELLS III, MD
N0945
MARINESCU, RODICA CATRINEL,
MD
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/3/2011
DALLAS
TX
ACTIVE
6/10/2011 None
N/A
8/29/2008
DALLAS
TX
ACTIVE
9/16/2008 None
N/A
CORAL
GABLES
FL
ACTIVE
8/1/2011 None
N/A
ATLANTA
GA
ACTIVE
8/18/2010 None
N/A
WORCESTER
MA
ACTIVE
4/4/2011 None
N/A
ALGONQUIN
IL
ACTIVE
10/10/2011 None
N/A
ACTIVE
4/29/2010 None
N/A
P0442
MENDEZ SOTO, DAVID B, MD
7/15/2011
N7464
MIRPURI, JULIE, MD
8/16/2010
N9101
MOSTAFA, KAMEL, MD
3/15/2011
P1114
NARULA, ARUN, MD
10/3/2011
N5917
OJADI, VALLIER CHIDI, MD
N8056
PRINCE, AUDRA MCCAY, MD
NEONATAL10/29/2010 10/29/2015 PERINATAL MEDICINE
ACTIVE
11/5/2010 None
N/A
N8344
SALDARRIAGA, ALINA , MD
ACTIVE
1/11/2011 None
N/A
P1223
SCHROEDER, ROBERT EUGENE,
MD
LICENSE
ISSUED
10/17/2011 None
N/A
P1411
SOMMERS, ROSS, MD
11/4/2011
LICENSE
ISSUED
11/4/2011 None
N/A
P0886
VIDAVALUR, RAMESH, MD
8/26/2011
NEONATALNEONATALPERINATAL
8/26/2016 PERINATAL MEDICINE MEDICINE
CUMBERLAND MD
9/6/2011 None
N/A
P3602
N3423
ACUN, CEYDA, MD
AHMED, NAGI HASSAN , MD
6/15/2012
8/21/2009
6/15/2017 NEONATOLOGY
MCKINNEY
6/15/2012 None
9/28/2009 None
N/A
N/A
4/9/2010
NEONATAL3/15/2016 PERINATAL MEDICINE NEONATOLOGY
NEONATALNEONATALPERINATAL
10/3/2016 PERINATAL MEDICINE MEDICINE
PEDIATRICS
PEDIATRICS
Page 172 of 301
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N3446
N9431
ANAYA, CARLOS , MD
BAIA, CATALINA, MD
8/21/2009
4/15/2011
H4886
P0182
N9186
P5347
CATER, GARY WAYNE, DO
CHAPMAN, JOHN CAYLOS, MD
CHEVURU, SRINIVAS, MD
CHONG, EUMING, MD
5/2/2011
7/1/2011
4/1/2011
2/1/2013
5/2/2016
7/1/2016
4/1/2016
2/1/2018
N9194
CONTRERAS, YVONNE MARIE, MD
4/1/2011
NEONATOLOGY
NEONATOLOGY
NEONATOLOGY
NEONATOLOGY
Secondary Specialty
(Self-Designated)
NEONATALPERINATAL
MEDICINE
PEDIATRICS
PEDIATRICS
PEDIATRICS
NEONATALPERINATAL
MEDICINE
Practice City
CORPUS
CHRISTI
ARLINGTON
Registration
Status of
Practice
Texas
State
License
TX
TX
TALLAHASSEE FL
HOUSTON
TX
TEXARKANA
TX
N1613
DIRNBERGER, DANIEL ROBERT,
MD
N9449
EPPLER, MAIA FIODOR, MD
4/15/2011
P1863
1/17/2012
2/5/2010
P2693
FOWLER, AJA JENELLE, MD
FREEMAN-LADD, MAYRA LOUISE,
MD
JOHNSON, KATHARINE MORTON,
MD
4/2/2012
SAN ANTONIO TX
N6398
N9249
JONES, PATRICK MARSH, MD
KNIGHT, SCOTT ALAN, MD
6/4/2010
4/1/2011
ASHLAND
P1558
P3379
N9263
KUREPA, DALIBOR, MD
LINGAPPAN, KRITHIKA , MD
MAYOR, REINA SARAH, MD
12/1/2011
6/1/2012
4/1/2011
PEDIATRICS
N4602
P6250
P7345
P0307
11/6/2009
4/12/2013
7/15/2013
7/1/2011
11/6/2014
4/12/2018
7/15/2018
7/1/2016
F7962
P5916
P6760
MOSSABEB, ROSCHANAK, MD
RAMACHANDRAN, SHALINI, MD
SAMBALINGAM, DEVARAJ, MD
TAO, JOSHUA DZKUAN, MD
WICKHAM, LAWRENCE KENNETH,
MD
ADAPA, SREEDHAR REDDY, MD
AGGARWAL, MONIKA, MD
INTERNAL MEDICINE PHILADELPHIA
DALLAS
PEDIATRICS
EL PASO
AUSTIN
NEWPORT
PEDIATRICS
BEACH
INTERNAL MEDICINE GAINESVILLE
INTERNAL MEDICINE
P1841
AHMED, IRFAN, MD
1/17/2012
N5057
12/12/2008 12/12/2013 NEONATOLOGY
4/1/2013
4/1/2013
6/3/2013
NEONATOLOGY
NEONATOLOGY
NEONATOLOGY
NEONATOLOGY
4/1/2018 NEPHROLOGY
6/3/2018 NEPHROLOGY
1/17/2017 NEPHROLOGY
LACKLAND
AFB
TX
PEDIATRICS
PEDIATRICS
PEDIATRICS
INTERNAL MEDICINE
Page 173 of 301
KY
SHREVEPORT LA
HOUSTON
TX
HOUSTON
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
ACTIVE
8/31/2009 None
4/28/2011 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
5/11/2011
7/7/2011
4/13/2011
2/6/2013
None
None
None
None
N/A
N/A
N/A
N/A
4/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
12/29/2008 None
N/A
4/15/2011 None
N/A
1/17/2012 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/4/2012 None
N/A
6/4/2010 None
4/13/2011 None
N/A
N/A
12/12/2011 None
6/4/2012 None
4/13/2011 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
PA
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
CA
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
2/8/2010
4/16/2013
7/18/2013
7/13/2011
None
None
None
None
N/A
N/A
N/A
N/A
4/5/2013 None
4/5/2013 None
6/7/2013 None
N/A
N/A
N/A
1/17/2012 None
N/A
License
Number
N4889
Physician Name
edicaid
edicaid
End Date
Designated)
N1530
AHMED, SANA MAHMOOD, MD
ANEKWE, EMMANUEL
CHUKWUEMEKA, MD
N5539
ASGAONKAR, ANIL V, MD
4/9/2010
4/9/2015 NEPHROLOGY
INTERNAL MEDICINE
P6331
AZIZ, NIVIN, MD
5/1/2013
5/1/2018 NEPHROLOGY
INTERNAL MEDICINE
N6185
BOUAJRAM, RAMI, MD
6/4/2010
6/4/2015 NEPHROLOGY
HOSPITALIST
N7908
BYREDDY, ANITHA, MD
CARBAJAL MENDOZA, ROGER
FRANCISCO, MD
P0559
2/5/2010
2/5/2015 NEPHROLOGY
Secondary Specialty
(Self-Designated)
INTERNAL MEDICINE
12/12/2008 12/12/2013 NEPHROLOGY
10/15/2010 10/15/2015 NEPHROLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SAN ANTONIO TX
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
12/29/2008 None
N/A
4/9/2010 None
N/A
5/1/2013 None
N/A
6/4/2010 None
N/A
10/15/2010 None
N/A
8/1/2011 None
N/A
8/1/2011
8/1/2016 NEPHROLOGY
CHEUNG, ERIC, MD
DE GOLOVINE, ALEKSANDRA
MARIA, MD
DEO, DATINDER BIR SINGH, MD
DEVIDOSS, SHARMILA , MD
DO, THONG HUY, MD
DYER, CHRISTOPHER ANTHONY,
MD
10/1/2012
INTERNAL MEDICINE
PEDIATRIC
NEPHROLOGY
HOUSTON
TX
ACTIVE
10/4/2012 None
N/A
5/2/2011
8/16/2010
3/1/2013
5/29/2009
5/2/2016
8/16/2015
3/1/2018
5/29/2014
NEPHROLOGY
NEPHROLOGY
NEPHROLOGY
NEPHROLOGY
HOUSTON
TX
INTERNAL MEDICINE WADSWORTH OH
INTERNAL MEDICINE
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
5/10/2011
9/20/2010
4/22/2013
7/20/2009
None
None
None
None
N/A
N/A
N/A
N/A
11/4/2011
ACTIVE
12/20/2011 None
N/A
1/15/2013
ACTIVE
1/23/2013 None
N/A
11/6/2009
ACTIVE
2/3/2010 None
N/A
4/8/2011
4/8/2016 NEPHROLOGY
TX
ACTIVE
4/18/2011 None
N/A
P5978
EL-KASS, GABRIEL, MD
EZEANUNA, PROSPERITY
UCHENNA , MD
FONTANILLA, JOHN RODOLFO GO,
MD
GOPALAKRISHNAN, RAJALAKSHMI
THIRUNELLAI, MD
GERIATRIC
MEDICINE (INTERNAL
MED)
BROOKLYN
NY
COLLEGE
INTERNAL MEDICINE SATION
TX
4/1/2013
4/1/2018 NEPHROLOGY
INTERNAL MEDICINE SAINT LOUIS
MO
4/10/2013 None
N/A
N6321
GORAYA, NIMRIT , MD
6/4/2010
6/4/2015 NEPHROLOGY
INTERNAL MEDICINE
6/4/2010 None
N/A
N6324
P5634
N8925
N9377
GOYAL, ABHIJEET, MD
GRANDHI, JAYASREE, MD
HEATH, KEVIN ALAN, MD
HOLT, SHEA RYAN, MD
IHEUKWUMERE, ESTHER
ORIEAKU, MD
6/4/2010
3/1/2013
3/1/2011
4/8/2011
6/4/2015
3/1/2018
3/1/2016
4/8/2016
INTERNAL MEDICINE
INTERNAL MEDICINE IRVING
TX
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
None
None
None
None
N/A
N/A
N/A
N/A
6/1/2012
6/1/2017 NEPHROLOGY
ACTIVE
6/20/2012 None
N/A
P4554
N9534
N7413
P5617
N3010
P1294
P5271
N4405
N9368
P3355
NEPHROLOGY
NEPHROLOGY
NEPHROLOGY
NEPHROLOGY
INTERNAL MEDICINE PARIS
Page 174 of 301
TX
6/4/2010
3/29/2013
3/14/2011
4/14/2011
License
Number
Physician Name
P7128
IQBAL, NADIA WASI, MD
P2874
JAIN, NISHANK, MD
P7652
JONES, KRISTIE ELIZABETH, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
Practice City
7/1/2013
7/1/2018 NEPHROLOGY
INTERNAL MEDICINE
4/13/2012
8/15/2013
P5539
KAISER, SHAUN, MD
2/8/2013
2/8/2018 NEPHROLOGY
N9238
4/1/2011
4/1/2016 NEPHROLOGY
INTERNAL MEDICINE
P1466
KAREEM, SOHAIL, MD
KARTOUMAH, ALMUTAZ BILLAH,
MD
11/15/2011 11/15/2016 NEPHROLOGY
INTERNAL MEDICINE
N3780
KAYAL, ANAS , MD
8/21/2009
INTERNAL MEDICINE
Registration
Status of
Practice
Texas
State
License
ACTIVE
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/15/2013 None
N/A
4/24/2012 None
N/A
8/16/2013 None
N/A
2/8/2013 None
N/A
4/1/2011 None
N/A
11/15/2011 None
N/A
11/19/2009 None
N/A
ACTIVE
ACTIVE
1/16/2012 None
3/23/2009 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
3/24/2009 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
11/6/2009 None
N/A
P1775
N2142
KEBEDE, TEWABE GIRMA, MD
KHAN, ASAD , MD
1/2/2012
2/6/2009
1/2/2017 NEPHROLOGY
2/6/2014 NEPHROLOGY
STOCKBRIDG
INTERNAL MEDICINE E
GA
INTERNAL MEDICINE HEARNE
TX
N2143
KHAN, FAISAL NAZIR AHMED, MD
2/6/2009
2/6/2014 NEPHROLOGY
INTERNAL MEDICINE BEEVILLE
N6436
KRISHNAMURTHY, GURURAJ, MD
6/4/2010
6/4/2015 NEPHROLOGY
INTERNAL MEDICINE
N5169
KUMAR, BIRESH , MD
2/5/2010
2/5/2015 NEPHROLOGY
N4535
KUNDI, IRFAN KARIM, MD
11/6/2009
INTERNAL MEDICINE
3/1/2013
6/3/2011
8/21/2009
2/1/2012
3/1/2018
6/3/2016
8/21/2014
2/1/2017
CORPUS
CHRISTI
INTERNAL MEDICINE LAS VEGAS
INTERNAL MEDICINE
TX
NV
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
3/20/2013
6/10/2011
10/2/2009
2/10/2012
None
None
None
None
N/A
N/A
N/A
N/A
8/21/2009
TX
8/26/2009 None
N/A
5/15/2012
INTERNAL MEDICINE
5/15/2012 None
N/A
2/5/2010
2/5/2015 NEPHROLOGY
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
2/5/2010 None
N/A
2/15/2011 None
11/17/2008 None
N/A
N/A
2/1/2013 None
9/18/2008 None
N/A
N/A
P5668
N9898
N3846
P2033
P3197
LEE, BENJAMIN SWEE LENG, MD
LOHIYA, PIYUSH SURESH, MD
LUNA-SALAZAR, CYNTHIA , MD
MAKADIA, PARIN M, MD
MANDAYAM, SREEDHAR AMMANJI,
MD
MANJAPPA, NAGARATHNA
GOWDA, MD
N5219
MANJUNATH, GURUPRASAD, MD
N8815
N0986
MARCIANO, DENISE K, MD
MIRZA, ABSAR A, MD
2/15/2011
8/29/2008
INTERNAL MEDICINE
INTERNAL MEDICINE GREENVILLE
SC
P5427
N1000
MOIZ, ABDUL, MD
MOURAD, SHADI MICHEL, MD
2/1/2013
8/29/2008
2/1/2018 NEPHROLOGY
INTERNAL MEDICINE
INTERNAL MEDICINE EAGLE PASS
TX
N3861
NEPHROLOGY
NEPHROLOGY
NEPHROLOGY
NEPHROLOGY
TX
Page 175 of 301
License
Number
Physician Name
N6519
P2042
P0645
NADELLA, RAMA, MD
NANGIA, SAMIR KUMAR, MD
NTENDE, HENRY WAKIKU, MD
P1006
OKUNDAYE, EBIMA CLIFFORD, MD
N5305
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
IL
ACTIVE
TX
ACTIVE
6/4/2010
2/1/2012
8/1/2011
6/4/2015 NEPHROLOGY
2/1/2017 NEPHROLOGY
8/1/2016 NEPHROLOGY
9/15/2011
INTERNAL MEDICINE
OTI, IFEATU UCHENNA, MD
2/5/2010
2/5/2015 NEPHROLOGY
INTERNAL MEDICINE
N6555
PAGANI, MARCO, MD
6/4/2010
6/4/2015 NEPHROLOGY
N7322
P2050
P1385
8/2/2010
2/1/2012
11/4/2011
8/2/2015 NEPHROLOGY
2/1/2017 NEPHROLOGY
INTERNAL MEDICINE
P0278
P4500
P1014
M8938
PARIKH, DIPEN SUBHASH, MD
PATEL, SHEETAL B, MD
PERIANAYAGAM, ANJANA, MD
RAAYASA, SRIKANTH
KRISHNAMURTHY, MD
RAJAN, THOMAS, MD
RANA, SHAUNAK, MD
RASHID, SUMIA , MD
7/1/2011
9/17/2012
9/15/2011
10/1/2012
7/1/2016
9/17/2017
9/15/2016
10/1/2017
INTERNAL MEDICINE KINGWOOD
TX
INTERNAL MEDICINE
INTERNAL MEDICINE ST LOUIS
MO
N5366
RODRIGUEZ, SIMON SERGIO, MD
2/5/2010
2/5/2015 NEPHROLOGY
INTERNAL MEDICINE
N2762
ROOPANI, GHAZALA QUDDUS, MD
4/3/2009
4/3/2014 NEPHROLOGY
INTERNAL MEDICINE BAY PINES
P0289
SANCHEZ-VELEZ, CATALINA , MD
7/1/2011
7/1/2016 NEPHROLOGY
N1438
N4720
N4721
P1403
SANGER, MATTHEW KERNAN, MD
SANKAR, SUDHEER KURUP, MD
SANKARAPANDIAN,
BALAMURUGAN PONNIAH, MD
SAROLIA, SEJAL PRAVIN, MD
P7853
P2521
P1593
SHAIKH, AISHA , MD
SHARMA, AMIT, MD
SHASTRI, SHANI, MD
P5135
SIA, JOHN PATRICK AGUILAR, MD
12/17/2012 12/17/2017 NEPHROLOGY
INTERNAL MEDICINE
P5135
12/17/2012 12/17/2017 NEPHROLOGY
INTERNAL MEDICINE OMAHA
NEPHROLOGY
NEPHROLOGY
NEPHROLOGY
NEPHROLOGY
10/10/2008 10/10/2013 NEPHROLOGY
11/6/2009
INTERNAL MEDICINE DESOTO
Registration
Status Date
Disciplinary
Status Date
6/4/2010 None
2/10/2012 None
8/25/2011 None
N/A
N/A
N/A
12/14/2011 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
8/2/2010 None
2/6/2012 None
11/22/2011 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
8/16/2011
12/7/2012
11/4/2011
10/8/2012
FL
INTERNAL MEDICINE METAIRIE
INTERNAL MEDICINE CINCINNATI
None
None
None
None
N/A
N/A
N/A
N/A
2/5/2010 None
N/A
ACTIVE
6/19/2009 None
N/A
TX
ACTIVE
8/15/2011 None
N/A
LA
OH
ACTIVE
ACTIVE
11/20/2008 None
12/7/2009 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
11/13/2009 None
11/8/2011 None
N/A
N/A
8/30/2013 None
3/26/2012 None
12/7/2011 None
N/A
N/A
N/A
12/17/2012 None
N/A
1/31/2013 None
N/A
11/6/2009
11/4/2011
TX
8/30/2013
3/15/2012
12/1/2011
INTERNAL MEDICINE MERIDIAN
Page 176 of 301
Disciplinary
Status of
Texas
License
ID
TX
NE
ACTIVE
License
Number
P5135
N1157
Physician Name
N5420
P3262
SOOD, VINEETA , MD
SUBRAMANIAM, SUBHASHINI
CIRUMANUR, MD
VANGURU, RAGHUVEER, MD
N6084
P1427
VAUGHN, CHARLES RAYMOND, DO
VELLANKI, VINITHA, MD
N6087
edicaid
edicaid
End Date
Designated)
12/17/2012 12/17/2017 NEPHROLOGY
8/29/2008
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
INTERNAL MEDICINE OMAHA
NE
TX
2/5/2010
5/15/2012
2/5/2015 NEPHROLOGY
INTERNAL MEDICINE
IL
4/9/2010
11/4/2011
4/9/2015 NEPHROLOGY
INTERNAL MEDICINE PECOS
INTERNAL MEDICINE RICHMOND
TX
VA
VIJ, RAJIV S B, MD
4/9/2010
4/9/2015 NEPHROLOGY
P1831
WANTHAKAWIKRAN, CHALIT , MD
1/2/2012
1/2/2017 NEPHROLOGY
P1710
P4919
WEHBE, EDGARD IBRAHIM, MD
YAN, JINGYIN , MD
P3384
LUPO, PAMELA , MD
P7234
ABUELEM, TAREK , MD
P6764
AL-HAFEZ, BARAA , MD
INTERNAL MEDICINE
12/15/2011 12/15/2016 NEPHROLOGY
11/15/2012 11/15/2017 NEPHROLOGY
NEURODEVELOPMEN
TAL DISABILITIES
6/1/2012
6/1/2017 (PEDIATRICS)
NEUROLOGICAL
7/15/2013
7/15/2018 SURGERY
NEUROLOGICAL
6/3/2013
6/3/2018 SURGERY
NEUROLOGICAL
4/3/2009
4/3/2014 SURGERY
NEUROLOGICAL
1/18/2011
1/18/2016 SURGERY
NEUROLOGICAL
9/15/2010
9/15/2015 SURGERY
NEUROLOGICAL
7/15/2013
7/15/2018 SURGERY
NEUROLOGICAL
6/14/2013
6/14/2018 SURGERY
N2379
ANDERSON, GLENN BRIAN, MD
N8485
BAIG, MIRZA NUSRUTULLAH, MD
N7676
BARTANUSZ, VIKTOR , MD
P7246
BENGLIS, DAVID MICHAEL JR, MD
P6951
BIDROS, DANI SIROP, MD
P0701
BOLLO, ROBERT JOHN, MD
8/15/2011
P5938
BRITZ, GAVIN WAYNE, MD
4/1/2013
N2967
BUCHANAN, ROBERT JOSEPH, MD
5/29/2009
NEUROLOGICAL
8/15/2016 SURGERY
NEUROLOGICAL
4/1/2018 SURGERY
NEUROLOGICAL
5/29/2014 SURGERY
HOUSTON
TX
INTERNAL MEDICINE
NEPHROLOGY
HOUSTON
TX
CHILD NEUROLOGY
TX
NEUROLOGICAL
SURGERY
HOUSTON
GALVESTON
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
1/31/2013 None
10/10/2008 None
N/A
N/A
2/5/2010 None
6/7/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/15/2010 None
11/18/2011 None
N/A
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
1/16/2012 None
N/A
12/15/2011 None
11/23/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
6/11/2012 None
N/A
7/15/2013 None
N/A
ACTIVE
6/10/2013 None
N/A
4/9/2009 None
N/A
1/18/2011 None
N/A
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
10/29/2010 None
N/A
ATLANTA
GA
ACTIVE
7/26/2013 None
N/A
PRINCETON
NJ
ACTIVE
6/24/2013 None
N/A
PEDIATRIC SURGERY
(NEUROLOGY)
HOUSTON
TX
ACTIVE
8/29/2011 None
N/A
HOUSTON
TX
ACTIVE
4/4/2013 None
N/A
TEMPLE
TX
ACTIVE
6/4/2009 None
N/A
Page 177 of 301
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
NEUROLOGICAL
P0179
CARDENAS, RAUL JOSE, MD
7/1/2011
7/1/2016 SURGERY
SPINE MEDICINE
NEUROLOGICAL
N5615
CHAUDHARI, ALOK MOHAN, MD
4/9/2010
4/9/2015 SURGERY
NEUROLOGICAL
P5168
DAGNEW, ELIAS, MD
1/4/2013
1/4/2018 SURGERY
NEUROLOGICAL
N1600
D'AGOSTINO, SABINO JOSEPH, DO 12/12/2008 12/12/2013 SURGERY
NEUROLOGICAL
P5527
DAY, ARTHUR LINWOOD, MD
2/8/2013
2/8/2018 SURGERY
ENDOVASCULAR
NEUROLOGICAL
SURGICAL
P7099
DIXON, TANYA STOYANOVA, DO
7/1/2013
7/1/2018 SURGERY
NEURORADIOLOGY
NEUROLOGICAL
N4387
DUHON, BRADLEY STUART, MD
11/6/2009
11/6/2014 SURGERY
DUNTSCH, CHRISTOPHER DANIEL,
NEUROLOGICAL
N8183
MD
12/1/2010
12/1/2015 SURGERY
EDDLEMAN, CHRISTOPHER SEAN,
NEUROLOGICAL
N5028
MD
2/5/2010
2/5/2015 SURGERY
NEUROLOGICAL
P1751
FEIGENBAUM, FRANK, MD
1/2/2012
1/2/2017 SURGERY
VASCULAR AND
NEUROLOGICAL
INTERVENTIONAL
N5673
FELICIANO, CALEB ENRIQUE, MD
4/9/2010
4/9/2015 SURGERY
RADIOLOGY
NEUROLOGICAL
P0208
FELTON, JASON ANDREW, MD
7/1/2011
7/1/2016 SURGERY
NEUROLOGICAL
N0769
FLOYD, JOHN ROBERT II, MD
8/29/2008
8/29/2013 SURGERY
NEURO-ONCOLOGY
NEUROLOGICAL
P0589
GASCO-TAMARIT, JAIME , MD
8/1/2011
8/1/2016 SURGERY
NEUROLOGICAL
P3342
HARVEY, ADRIAN TIMOTHY, DO
6/1/2012
6/1/2017 SURGERY
NEUROLOGICAL
CRITICAL CARE N6359
HOLLAND, MARTIN CARLOS, MD
6/4/2010
6/4/2015 SURGERY
NEUROSURGERY
NEUROLOGICAL
P6977
HOOD, BRIAN JAMES, MD
6/14/2013
6/14/2018 SURGERY
HOOVER, JASON MARSHALL
NEUROLOGICAL
P6641
THOMAS, MD
5/15/2013
5/15/2018 SURGERY
NEUROLOGICAL
P4965
HSIEH, JOSEPH CHIA-YU, MD
11/30/2012 11/30/2017 SURGERY
Page 178 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
7/8/2011 None
N/A
ZANESVILLE
OH
ACTIVE
4/28/2010 None
N/A
SUWANEE
GA
ACTIVE
2/13/2013 None
N/A
SAN ANGELO
TX
ACTIVE
12/29/2008 None
N/A
HOUSTON
TX
ACTIVE
2/13/2013 None
N/A
ACTIVE
LICENSE
ISSUED
8/23/2013 None
N/A
11/6/2009 None
N/A
ACTIVE
LICENSE
ISSUED
12/9/2010 None
N/A
2/5/2010 None
N/A
FORT WORTH TX
KANSAS CITY MO
ACTIVE
1/9/2012 None
N/A
SAN JUAN
PR
ACTIVE
4/27/2010 None
N/A
LUBBOCK
TX
ACTIVE
7/28/2011 None
N/A
SAN ANTONIO TX
ACTIVE
9/5/2008 None
N/A
GALVESTON
TX
ACTIVE
9/6/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/5/2012 None
N/A
6/4/2010 None
N/A
6/14/2013 None
N/A
5/23/2013 None
N/A
11/30/2012 None
N/A
BRYAN
TX
ACTIVE
LICENSE
ISSUED
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
JATAVALLABHULA, NARASIMHA
NEUROLOGICAL
P6650
SASTRY, MD
5/15/2013
5/15/2018 SURGERY
NEUROLOGICAL
P6837
JERNIGAN, SARAH, MD
6/3/2013
6/3/2018 SURGERY
NEUROLOGICAL
N6405
KAMATH, YOGISH DASAPPA, MD
6/4/2010
6/4/2015 SURGERY
NEUROLOGICAL
N2167
LEE, MARK ROBERT, MD
2/6/2009
2/6/2014 SURGERY
NEUROLOGICAL
P2029
LIVINGSTON, ANDREW DALE, MD
2/1/2012
2/1/2017 SURGERY
NEUROLOGICAL
N5820
MACDONALD, BART ALLEN, MD
4/9/2010
4/9/2015 SURGERY
NEUROLOGICAL
NEUROLOGICAL
N3851
MACIAS, MELISSA YVONNE, MD
8/21/2009
8/21/2014 SURGERY
SURGERY
ENDOVASCULAR
NEUROLOGICAL
SURGICAL
L8424
MAIORIELLO, ANTHONY VITO, MD
6/4/2010
6/4/2015 SURGERY
NEURORADIOLOGY
NEUROLOGICAL
CRITICAL CARE P3038
MARKO, NICHOLAS FRANK, MD
5/1/2012
5/1/2017 SURGERY
NEUROSURGERY
NEUROLOGICAL
N9745
MESFIN, FASSIL B, MD
5/16/2011
5/16/2016 SURGERY
NEUROLOGICAL
H9239
MEYER, YVES JEAN, MD
5/15/2013
5/15/2018 SURGERY
NEUROLOGICAL
N6497
MISSIOS, SYMEON, MD
6/4/2010
6/4/2015 SURGERY
NEUROLOGICAL
P6231
OH, MICHAEL CHIHONG, MD
4/12/2013
4/12/2018 SURGERY
ORTEGA BARNETT, JUAN RAMON,
NEUROLOGICAL
P5117
MD
12/17/2012 12/17/2017 SURGERY
NEUROLOGICAL
P5117
MD
12/17/2012 12/17/2017 SURGERY
NEUROLOGICAL
P5117
MD
12/17/2012 12/17/2017 SURGERY
NEUROLOGICAL
P1127
PATIL, SHASHIKANT, MD
10/3/2011
10/3/2016 SURGERY
PAULLUS, WAYNE CLIFFORD III,
NEUROLOGICAL
N9277
MD
4/1/2011
4/1/2016 SURGERY
NEUROLOGICAL
P7336
RAHHAL, RYAN FOUAD, MD
7/15/2013
7/15/2018 SURGERY
NEUROLOGICAL
P6703
RAMAKRISHNA, ROHAN, MD
5/15/2013
5/15/2018 SURGERY
Page 179 of 301
Practice City
LONGVIEW
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/17/2013 None
N/A
6/3/2013 None
N/A
6/4/2010 None
N/A
3/25/2009 None
N/A
2/1/2012 None
N/A
5/3/2010 None
N/A
8/26/2009 None
N/A
6/4/2010 None
N/A
AUSTIN
TX
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
HOUSTON
CORPUS
CHRISTI
TX
ACTIVE
TX
DAVENPORT
IA
ACTIVE
TEXAS
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
5/3/2012 None
N/A
HOUSTON
TX
ACTIVE
5/24/2011 None
N/A
ACTIVE
LICENSE
ISSUED
5/16/2013 None
N/A
6/4/2010 None
N/A
FORT WORTH TX
SAN
FRANCISCO
CA
ACTIVE
4/26/2013 None
N/A
GALVESTON
TX
ACTIVE
12/18/2012 None
N/A
GALVESTON
TX
ACTIVE
12/18/2012 None
N/A
GALVESTON
TX
ACTIVE
12/18/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/17/2011 None
N/A
4/1/2011 None
N/A
7/15/2013 None
N/A
5/29/2013 None
N/A
SHREVEPORT LA
HOUSTON
TX
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
NEUROLOGICAL
12/12/2008 12/12/2013 SURGERY
N1852
REDMOND, ANDY JUNEY, MD
P3236
SANDBERG, DAVID ILAN, MD
P5134
SHAKIR, AHMED RAZA, MD
12/17/2012
P5134
12/17/2012
P5134
12/17/2012
P2370
SON, COLIN TOWNES, MD
3/1/2012
P2381
TATSUI, CLAUDIO ESTEVES, MD
3/1/2012
P6733
TAUB, JASON SCOTT, MD
P7579
TAYAG, EMILIO CARREON, MD
8/1/2013
N9655
THAI, QUOC-ANH, MD
5/2/2011
P7592
VASUDEVAN, RAM RAJ, MD
8/1/2013
P5247
WANG, VINCENT YAT-CHUNG, MD
1/4/2013
P1718
ZIU, MATEO , MD
N6798
ZUBAY, GEOFFREY PYONG, MD
5/15/2012
5/15/2013
12/15/2011
6/4/2010
NEUROLOGICAL
5/15/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
3/1/2017 SURGERY
NEUROLOGICAL
3/1/2017 SURGERY
NEUROLOGICAL
5/15/2018 SURGERY
NEUROLOGICAL
8/1/2018 SURGERY
NEUROLOGICAL
5/2/2016 SURGERY
NEUROLOGICAL
8/1/2018 SURGERY
NEUROLOGICAL
1/4/2018 SURGERY
NEUROLOGICAL
12/15/2016 SURGERY
NEUROLOGICAL
6/4/2015 SURGERY
N2896
ACOSTA, INDRANI ENID, MD
5/29/2009
5/29/2014 NEUROLOGY
P5769
ALBERTS, MARK J, MD
3/15/2013
3/15/2018 NEUROLOGY
N5527
ALBO, ZIMBUL , MD
4/9/2010
4/9/2015 NEUROLOGY
P4843
P2413
ALI, ISHAQ, MD
ALICK, SASHA , MD
11/15/2012 11/15/2017 NEUROLOGY
3/15/2012
3/15/2017 NEUROLOGY
P1157
ANDERSON, GINA KATHLEEN, DO
10/17/2011 10/17/2016 NEUROLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
1/2/2009 None
N/A
ACTIVE
5/16/2012 None
N/A
ACTIVE
1/4/2013 None
N/A
ACTIVE
1/4/2013 None
N/A
ACTIVE
1/4/2013 None
N/A
SAN ANTONIO TX
ACTIVE
3/20/2012 None
N/A
HOUSTON
TX
ACTIVE
3/19/2012 None
N/A
DALLAS
TX
ACTIVE
5/17/2013 None
N/A
ACTIVE
8/20/2013 None
N/A
ACTIVE
5/5/2011 None
N/A
ACTIVE
8/9/2013 None
N/A
ACTIVE
1/22/2013 None
N/A
1/5/2012 None
N/A
6/4/2010 None
N/A
TX
NEUROLOGY
HOUSTON
SUGAR LAND
TX
TX
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
6/10/2009 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
3/21/2013 None
N/A
4/9/2010 None
N/A
ACTIVE
ACTIVE
12/31/2012 None
3/20/2012 None
N/A
N/A
ACTIVE
11/7/2011 None
N/A
NEURO-PHYSIOLOGY
(NEUROLOGY)
COLLEGE
STATION
Page 180 of 301
Disciplinary
Status Date
ACTIVE
PEDIATRIC SURGERY
(NEUROLOGY)
HOUSTON
VASCULAR
NEUROLOGY
VASCULAR
NEUROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
Physician Name
N4252
ANSARI, SAFDAR ABBAS, MD
P2947
AQUINO, KAREN MARGHANITA, MD
edicaid
edicaid
End Date
Designated)
11/6/2009
11/6/2014 NEUROLOGY
5/1/2012
Secondary Specialty
(Self-Designated)
5/1/2017 NEUROLOGY
P5777
BEH, SHIN CHIEN, MD
3/15/2013
3/15/2018 NEUROLOGY
N3503
N3524
P7620
P3614
BIRNBAUM, LEE ALBERT, MD
BURTON, ERIK VON, MD
CHANG, TIFFANY, MD
CHAUDHRY, PRIYANKA , MD
8/21/2009
8/21/2009
8/15/2013
6/15/2012
8/21/2014
8/21/2014
8/15/2018
6/15/2017
P1061
10/3/2011
10/3/2016 NEUROLOGY
N8172
N0696
CHEN, MERRY, MD
CHEN, SHERMAN HSIEN-CHANG,
MD
CHENNU, YAMINI PADMA, MD
12/1/2010
8/29/2008
12/1/2015 NEUROLOGY
8/29/2013 NEUROLOGY
N5620
CHERIAN, VENEETHA , MD
4/9/2010
4/9/2015 NEUROLOGY
P2838
CHOI, HUIMAHN ALEX, MD
4/13/2012
4/13/2017 NEUROLOGY
N7999
P4641
COOPER, EDWARD CLISSOLD, MD
DE JESUS, MARIA AUDRIE, MD
P4563
DEIPARINE, JULIUS F, MD
10/1/2012
10/1/2017 NEUROLOGY
N9361
P6605
DETOLEDO, JOAO CARLOS, MD
DING, KAN , MD
4/8/2011
5/15/2013
4/8/2016 NEUROLOGY
5/15/2018 NEUROLOGY
NEUROLOGY
NEUROLOGY
NEUROLOGY
NEUROLOGY
AUSTIN
NEUROOPHTHALMOLOGY
VASCULAR
NEUROLOGY
EDGELL, RANDALL CLIVE, MD
1/4/2013
1/4/2018 NEUROLOGY
P7761
EDWARDS, NANCY JEAN, MD
8/30/2013
8/30/2018 NEUROLOGY
N6862
EL KHOURY, RAMY , MD
7/1/2010
7/1/2015 NEUROLOGY
N5037
ENCARNACION, ELMYRA V., MD
2/5/2010
2/5/2015 NEUROLOGY
P0207
FANG, XIANG , MD
7/1/2011
7/1/2016 NEUROLOGY
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/30/2009 None
N/A
ACTIVE
LICENSE
ISSUED
5/7/2012 None
N/A
3/15/2013 None
N/A
8/27/2009
9/2/2009
8/20/2013
6/19/2012
None
None
None
None
N/A
N/A
N/A
N/A
SAN ANTONIO
DALLAS
DALLAS
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
NEURO-PHYSIOLOGY
(NEUROLOGY)
HOUSTON
TX
ACTIVE
10/24/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
12/23/2010 None
9/11/2008 None
N/A
N/A
4/9/2010 None
N/A
4/13/2012 None
N/A
10/29/2010 None
11/28/2012 None
N/A
N/A
10/19/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/8/2011 None
5/23/2013 None
N/A
N/A
TX
ACTIVE
2/21/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
9/5/2013 None
N/A
7/1/2010 None
N/A
2/5/2010 None
N/A
7/1/2011 None
N/A
NEUROLOGY
NEUROOPTHAMOLOGY
10/29/2010 10/29/2015 NEUROLOGY
10/15/2012 10/15/2017 NEUROLOGY
P5174
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
DALLAS
TX
FORT WORTH TX
GREENVILLE
NEURO-PHYSIOLOGY
(NEUROLOGY)
BEAUMONT
DALLAS
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
HOUSTON
HOUSTON
VASCULAR
NEUROLOGY
MOVEMENT
DISORDERS
Page 181 of 301
TX
TX
License
Number
N9545
P5804
P3623
P3624
P1864
N9703
Physician Name
FIGUEROA, STEPHEN ANDREW,
MD
FONG, ALEXANDER ERIC, MD
FONKEM, EKOKOBE, DO
FRANCESCONI, JAMES EDWARD,
MD
FRIEDMAN, DEBORAH ISA, MD
GEORGIADIS, ALEXANDROS
LAZAROS, MD
edicaid
edicaid
End Date
Designated)
5/2/2011
Secondary Specialty
(Self-Designated)
5/2/2016 NEUROLOGY
3/15/2013
6/15/2012
3/15/2018 NEUROLOGY
6/15/2017 NEUROLOGY
6/15/2012
6/15/2017 NEUROLOGY
1/17/2012
1/17/2017 NEUROLOGY
5/16/2011
5/16/2016 NEUROLOGY
VASCULAR
NEUROLOGY
NEURO-ONCOLOGY
NEUROOPHTHALMOLOGY
P3532
P6623
GIANATASIO, RYAN MARTIN, MD
GOLI, KRISHNA, MD
6/8/2012
5/15/2013
6/8/2017 NEUROLOGY
5/15/2018 NEUROLOGY
VASCULAR
NEUROLOGY
NEURO-ONCOLOGY
P6625
GONZALEZ MONTOYA, VICTOR
HUGO, MD
5/15/2013
5/15/2018 NEUROLOGY
CLINICAL
NEUROPHYSIOLOGY
6/15/2011
6/15/2016 NEUROLOGY
NEURO-ONCOLOGY
P0056
P1253
GONZALEZ, JAVIER , MD
GONZALEZ-SCARANO,
FRANCISCO ANTONIO, MD
10/17/2011 10/17/2016 NEUROLOGY
N9564
HANSEN, PAUL ADRIAN, MD
5/2/2011
5/2/2016 NEUROLOGY
P2006
HARRIS, JEFFREY THEODORE, MD
2/1/2012
2/1/2017 NEUROLOGY
P2455
HASSAN, AMEER ELSAYED, DO
3/15/2012
3/15/2017 NEUROLOGY
N7102
7/15/2010
7/15/2015 NEUROLOGY
P0602
HENDLEY, KATIE LEIGHANNE, MD
HERATH, PRIYANTHA PUSHPA
KUMARA, MD
P0226
HICKS, WILLIAM JAMES II, MD
8/1/2011
8/1/2016 NEUROLOGY
7/1/2011
7/1/2016 NEUROLOGY
P2678
HUSSAIN, YESSAR M, MD
4/2/2012
4/2/2017 NEUROLOGY
J6499
JACKSON, GEORGE ROBERT, MD
6/4/2010
6/4/2015 NEUROLOGY
N4495
JAFRI, AHMED HASSAN, MD
11/6/2009
Practice City
Registration
Status of
Practice
Texas
State
License
11/6/2014 NEUROLOGY
NEUROMUSCULAR
DISEASE
VASCULAR
NEUROLOGY
Page 182 of 301
ACTIVE
5/6/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
4/23/2013 None
6/18/2012 None
N/A
N/A
SHERMAN
TX
ACTIVE
6/20/2012 None
N/A
DALLAS
TX
ACTIVE
1/23/2012 None
N/A
ACTIVE
5/20/2011 None
N/A
ACTIVE
ACTIVE
6/13/2012 None
7/12/2013 None
N/A
N/A
5/15/2013 None
N/A
6/15/2011 None
N/A
10/25/2011 None
N/A
5/9/2011 None
N/A
2/1/2012 None
N/A
PLANO
VICKSBURG
TX
MS
LICENSE
ISSUED
LICENSE
ISSUED
SAN ANTONIO TX
MOVEMENT
DISORDERS
Disciplinary
Status Date
HOUSTON
TEMPLE
VASCULAR
NEUROLOGY
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
HARLINGEN
TX
ACTIVE
3/28/2012 None
N/A
HOUSTON
TX
ACTIVE
7/19/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/6/2011 None
N/A
7/1/2011 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
4/18/2012 None
N/A
6/4/2010 None
N/A
11/11/2009 None
N/A
ROUND ROCK TX
AUSTIN
DALLAS
TX
TX
ACTIVE
License
Number
N8799
Physician Name
KALAMANGALAM, GIRIDHAR P, MD
TM00395 KALANITHI, SUMAN ARUL, MD
KALKONDE, YOGESHWAR
N4504
VIDYADHAR, MD
N3776
KARKAR, KAMEEL MICHEL, MD
P5396
KIDD, MATTHEW CHARLES, DO
P4585
KIM, JONGYEOL , MD
P0248
edicaid
edicaid
End Date
Designated)
2/15/2011
Secondary Specialty
(Self-Designated)
Practice City
2/15/2016 NEUROLOGY
10/15/2010 10/15/2015 NEUROLOGY
11/6/2009
8/21/2009
2/1/2013
11/6/2014 NEUROLOGY
8/21/2014 NEUROLOGY
2/1/2018 NEUROLOGY
VASCULAR
NEUROLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
10/3/2012 None
N/A
NM
ACTIVE
7/6/2011 None
N/A
TX
ACTIVE
1/31/2012 None
N/A
6/6/2012 None
N/A
2/5/2010 None
N/A
P1777
KRISHNA, VIVEK RAJ, MD
1/2/2012
1/2/2017 NEUROLOGY
NEURO-PHYSIOLOGY ALAMOGORD
(NEUROLOGY)
O
NEUROMUSCULAR
DISEASE
GALVESTON
P3375
LABAULT-SANTIAGO, JOSE
RAFAEL, MD
6/1/2012
6/1/2017 NEUROLOGY
NEURO-PHYSIOLOGY
(NEUROLOGY)
SAN ANTONIO TX
N5177
LANDFIELD, ALEXANDER, MD
2/5/2010
2/5/2015 NEUROLOGY
P4973
N8208
LAZARIDIS, CHRISTOS , MD
LE, CHUONG, MD
P2717
LEE, KIWON, MD
P7302
LIANG, QINGHUA, MD
N9892
N9894
P2896
LIE, OCTAVIAN VIOREL, MD
LINCOLN, JOHN ANIL, MD
LUJAN PALMA, JOSE ALFREDO,
MD
MAGADAN, ALEJANDRO ALFONSO,
MD
N5825
N9900
P5685
MAHADEVA, BRANAVEN, MD
MANI, RANJEETA, MD
MESSING, ROBERT OWEN, MD
P5109
MIOCINOVIC, SVJETLANA, MD
N7832
7/15/2013
7/15/2018 NEUROLOGY
6/3/2011
6/3/2011
6/3/2016 NEUROLOGY
6/3/2016 NEUROLOGY
10/1/2010
10/1/2015 NEUROLOGY
4/13/2012
4/13/2017 NEUROLOGY
4/9/2010
6/3/2011
3/1/2013
4/9/2015 NEUROLOGY
6/3/2016 NEUROLOGY
3/1/2018 NEUROLOGY
12/17/2012 12/17/2017 NEUROLOGY
MOVEMENT
DISORDERS
Page 183 of 301
ACTIVE
LICENSE
ISSUED
CHARLESTON SC
NASHVILLE
TN
ACTIVE
ACTIVE
1/8/2013 None
1/31/2011 None
N/A
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
4/16/2012 None
N/A
7/15/2013 None
N/A
ACTIVE
ACTIVE
6/13/2011 None
6/13/2011 None
N/A
N/A
TX
CLINICAL
NEUROPHYSIOLOGY SAN ANTONIO TX
HOUSTON
TX
VASCULAR
NEUROLOGY
NEUROMUSCULAR
DISEASE
SLEEP MEDICINE
N/A
LUBBOCK
7/1/2016 NEUROLOGY
MOVEMENT
DISORDERS
10/15/2010 None
N/A
N/A
N/A
7/1/2011
4/2/2017 NEUROLOGY
N/A
11/16/2009 None
8/26/2009 None
2/5/2013 None
KOGANTI, MADHURI LATHA, MD
4/2/2012
2/15/2011 None
ACTIVE
ACTIVE
ACTIVE
10/1/2017 NEUROLOGY
VASCULAR
NEUROLOGY
Disciplinary
Status Date
SAN ANTONIO TX
EL PASO
TX
10/1/2012
11/30/2012 11/30/2017 NEUROLOGY
12/1/2010
12/1/2015 NEUROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ROSWELL
NM
ACTIVE
10/26/2010 None
N/A
BETHESDA
MD
ACTIVE
4/20/2012 None
N/A
DETROIT
AUSTIN
MI
TX
ACTIVE
ACTIVE
ACTIVE
4/20/2010 None
6/10/2011 None
3/14/2013 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
12/24/2012 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P5109
12/17/2012 12/17/2017 NEUROLOGY
P5109
12/17/2012 12/17/2017 NEUROLOGY
P2307
MOORE, DAVID FRANCIS, MD
N3918
3/1/2012
3/1/2017 NEUROLOGY
MUPPIDI, SRIKANTH , MD
8/21/2009
8/21/2014 NEUROLOGY
P6685
MURTHY, SANTOSH BHASKAR, MD
5/15/2013
5/15/2018 NEUROLOGY
N6520
P7166
N4620
NAEEM, MUHAMMAD, MD
NAVALKELE, DIGVIJAYA D, MD
NGUYEN, THY PHUONG, MD
6/4/2010
7/1/2013
11/6/2009
6/4/2015 NEUROLOGY
7/1/2018 NEUROLOGY
11/6/2014 NEUROLOGY
P2322
3/1/2012
3/1/2017 NEUROLOGY
8/30/2013
8/29/2008
5/1/2013
8/30/2018 NEUROLOGY
8/29/2013 NEUROLOGY
5/1/2018 NEUROLOGY
N4871
N3965
NINAN, RONY , MD
NUNEZ-WALLACE, KAREN ROSA,
MD
OKAI, ANNETTE , MD
OKUDA, DARIN T, MD
OOMMEN, KALARICKAL JOSEPH,
MD
ORTSTADT, JEFFREY LEON, MD
11/6/2009
8/21/2009
11/6/2014 NEUROLOGY
8/21/2014 NEUROLOGY
N2709
PAK, EUGENE , MD
4/3/2009
4/3/2014 NEUROLOGY
N9397
PATEL, NEEPA JAYANT, MD
4/8/2011
4/8/2016 NEUROLOGY
P6888
PEREZ, ANGEL S, MD
6/3/2013
6/3/2018 NEUROLOGY
P2760
QIU, CUIE , MD
4/2/2012
4/2/2017 NEUROLOGY
P7547
P5302
RAMIREZ, CARMEN TERESA, MD
RASHID, SAMIYA, DO
8/1/2013
1/15/2013
8/1/2018 NEUROLOGY
1/15/2018 NEUROLOGY
P0280
RECIO-RESTREPO, MARIA
VICTORIA, MD
7/1/2011
7/1/2016 NEUROLOGY
N6609
REHMAN, ATTA UR, MD
6/4/2010
6/4/2015 NEUROLOGY
N1111
ROMERO, REBECCA SUZANNE, MD
8/29/2008
8/29/2013 NEUROLOGY
P7824
N1030
P6483
Secondary Specialty
(Self-Designated)
MOVEMENT
DISORDERS
MOVEMENT
DISORDERS
VASCULAR
NEUROLOGY
NEUROMUSCULAR
DISEASE
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
12/24/2012 None
N/A
DALLAS
TX
ACTIVE
12/24/2012 None
N/A
DALLAS
TX
ACTIVE
3/28/2012 None
N/A
DALLAS
TX
ACTIVE
9/9/2009 None
N/A
BALTIMORE
MD
6/7/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/4/2010 None
7/8/2013 None
1/12/2010 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
3/8/2012 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
ACTIVE
9/5/2013 None
9/8/2008 None
5/7/2013 None
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
11/16/2009 None
9/2/2009 None
N/A
N/A
TX
ACTIVE
4/10/2009 None
N/A
ACTIVE
4/18/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/21/2013 None
N/A
4/2/2012 None
N/A
8/1/2013 None
1/18/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/12/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
9/26/2008 None
N/A
NEUROPHYSIOLOGYNEUROLOGY
LUBBOCK
SLEEP MEDICINE
DALLAS
WICHITA
FALLS
MOVEMENT
DISORDERS
FAYETTEVILLE AR
IRVING
AUSTIN
NEURO-PHYSIOLOGY
(NEUROLOGY)
DALLAS
VASCULAR
NEUROLOGY
CHICAGO
Page 184 of 301
Disciplinary
Status Date
DALLAS
SLEEP MEDICINE
NEUROMUSCULAR
DISEASE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TX
IL
License
Number
P2776
Physician Name
SADEGHI, MOHAMMADREZA, MD
N7340
P1018
SANKA, RATNA KIRAN, MD
SANTOS, ALBERTO MOURA, MD
K4229
SAPERSTEIN, DAVID SCOTT, MD
N6001
SAW, ANDREW M, MD
N8850
P5724
P7854
P4714
P2372
SHAD, ASFA YOUSAF, DO
SHAH, SHREYANSH DINESH, MD
SHARRIEF, ANJAIL ZARINAH, MD
SHULMAN, JOSHUA M, MD
SPANN, BRYAN MICHAEL-PAUL,
DO
N6687
STEPHENSON, SHARISSE, MD
P2374
STEVENSON, MATTHEW
TERRENCE, MD
edicaid
edicaid
End Date
Designated)
4/2/2012
8/2/2010
9/15/2011
8/2/2015 NEUROLOGY
9/15/2016 NEUROLOGY
4/9/2015 NEUROLOGY
2/15/2011
2/15/2016
3/1/2013
3/1/2018
8/30/2013
8/30/2018
10/15/2012 10/15/2017
NEUROLOGY
NEUROLOGY
NEUROLOGY
NEUROLOGY
3/1/2012
3/1/2017 NEUROLOGY
6/4/2010
6/4/2015 NEUROLOGY
3/1/2012
3/1/2017 NEUROLOGY
P7216
P7042
SURI, MUHAMMAD FAREED KHAN,
MD
TANEJA, AANCHAL , MD
TEKLE, WONDWOSSEN
GEBREAMANUEL, MD
TEN PAS, SHERRI L, DO
P2070
THENGANATT, MARY ANN, MD
N7182
THIRUNARAYANAN, SUPRIYA , MD
7/15/2010
7/15/2015 NEUROLOGY
THOMAS, ABRAHAM PALAMOOTIL,
MD
7/1/2013
7/1/2018 NEUROLOGY
THUMMALA, SUNIL KUMAR REDDY,
MD
6/3/2011
6/3/2016 NEUROLOGY
TREMONT LUKATS, IVO
WIGBERTO, MD
10/10/2008 10/10/2013 NEUROLOGY
TSUI, ANNIE YEEWEN, DO
4/12/2013
4/12/2018 NEUROLOGY
VALDEZ ARROYO, SHERLEY
ROSE, MD
8/29/2008
8/29/2013 NEUROLOGY
P3250
N7973
P7219
N9970
N1483
P6290
N1198
Practice City
4/2/2017 NEUROLOGY
10/17/2011 10/17/2016 NEUROLOGY
4/9/2010
Secondary Specialty
(Self-Designated)
5/15/2012
5/15/2017 NEUROLOGY
10/15/2010 10/15/2015 NEUROLOGY
7/1/2013
6/14/2013
7/1/2018 NEUROLOGY
6/14/2018 NEUROLOGY
2/1/2012
2/1/2017 NEUROLOGY
NEUROMUSCULAR
DISEASE
SAN ANTONIO
SLEEP MEDICINE
NEUROMUSCULAR
DISEASE
BENBROOK
ELECTRODIAGNOSTI
C MEDICINE
TYLER
HOUSTON
HOUSTON
NEUROLOGY
HOUSTON
HOUSTON
NEURO-PHYSIOLOGY
(NEUROLOGY)
FORT WORTH
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
DALLAS
INTERVENTIONAL
RADIOLOGY
HARLINGEN
SLEEP MEDICINE
TYLER
MOVEMENT
DISORDERS
NY
VASCULAR
NEUROLOGY
HOUSTON
NEURO-ONCOLOGY
GENERAL PRACTICE
Page 185 of 301
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/2/2012 None
N/A
TX
ACTIVE
ACTIVE
8/5/2010 None
12/8/2011 None
N/A
N/A
TX
ACTIVE
10/27/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
4/26/2010 None
N/A
TX
TX
TX
TX
ACTIVE
LICENSE
ISSUED
2/15/2011
3/5/2013
9/4/2013
10/31/2012
None
None
None
None
N/A
N/A
N/A
N/A
3/5/2012 None
N/A
6/4/2010 None
N/A
3/12/2012 None
N/A
5/15/2012 None
10/20/2010 None
N/A
N/A
TX
ACTIVE
TX
LICENSE
ISSUED
ACTIVE
TX
TX
ACTIVE
ACTIVE
7/25/2013 None
6/19/2013 None
N/A
N/A
NY
ACTIVE
LICENSE
ISSUED
2/15/2012 None
N/A
7/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/8/2013 None
N/A
6/3/2011 None
N/A
ACTIVE
ACTIVE
1/6/2009 None
4/18/2013 None
N/A
N/A
ACTIVE
9/17/2008 None
N/A
TX
HOUSTON
TX
ROUND ROCK TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P5901
VAN BOVEN, ROBERT WAYNE, MD
3/15/2013
3/15/2018 NEUROLOGY
P2077
2/1/2012
2/1/2017 NEUROLOGY
P0149
VARGA, MARIANA GEORGETA, MD
VENKATASUBBA RAO, CHETHAN
PADAVANAPALLI, MD
N7372
VERMA, AVESH RAJA, MD
N5460
VERONA, MONTGOMERY ALAN,
MD
VERTREES, STEPHANIE MICHAEL,
MD
VIJAYAPPA, MADHU
BUKKASAGARA, MD
P3094
N4192
WALN, OLGA , MD
WANG, NORMAN C, MD
K0232
P3477
6/15/2011
6/15/2016 NEUROLOGY
8/2/2010
8/2/2015 NEUROLOGY
6/4/2010
6/4/2015 NEUROLOGY
6/1/2012
6/1/2017 NEUROLOGY
2/5/2010
2/5/2015 NEUROLOGY
5/1/2012
8/21/2009
5/1/2017 NEUROLOGY
8/21/2014 NEUROLOGY
1/17/2012
1/17/2017 NEUROLOGY
Secondary Specialty
(Self-Designated)
Practice City
LAKEWAY
TX
ACTIVE
AUSTIN
TX
CLINICAL
NEUROPHYSIOLOGY DALLAS
NEUROMUSCULAR
DISEASE
NEUROLOGY
MOVEMENT
DISORDERS
VASCULAR
NEUROLOGY
IN
AUSTIN
TX
4/3/2013 None
N/A
ACTIVE
LICENSE
ISSUED
2/13/2012 None
N/A
6/15/2011 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
8/20/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/8/2012 None
N/A
2/5/2010 None
N/A
5/10/2012 None
9/14/2009 None
N/A
N/A
ACTIVE
ACTIVE
AUSTIN
TX
ACTIVE
NJ
ACTIVE
TX
ACTIVE
ACTIVE
5/24/2011 None
4/28/2010 None
N/A
N/A
TX
ACTIVE
8/20/2013 None
N/A
TX
11/7/2011 None
N/A
OK
OK
OK
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
8/15/2013
12/21/2012
12/21/2012
12/21/2012
None
None
None
None
N/A
N/A
N/A
N/A
WI
ACTIVE
12/13/2010 None
N/A
TX
ACTIVE
11/28/2011 None
N/A
WEINTRAUB, BERNARD MAURICE,
MD
N9795
N5516
WINSTON, NICOLE, MD
WU, CHUANG-KUO, MD
5/16/2011
4/9/2010
5/16/2016 NEUROLOGY
4/9/2015 NEUROLOGY
P7727
WU, LAURA JUICHEN, MD
8/15/2013
8/15/2018 NEUROLOGY
INTERNAL MEDICINE NEWTON
NEUROMUSCULAR
DISEASE
LUBBOCK
MOVEMENT
DISORDERS
TYLER
P1440
YOUNG ACHONG MEJIA, ANGELA
MARIA, MD
11/4/2016 NEUROLOGY
NEURO-PHYSIOLOGY
(NEUROLOGY)
DALLAS
P7731
P5150
P5150
P5150
ZACHARATOS, HARALABOS, DO
ZUBAIR, SALMAN, MD
ZUBAIR, SALMAN, MD
ZUBAIR, SALMAN, MD
N8196
JAFFRI, MOSSADIQ S, MD
P1467
KOZMINSKI, MATTHEW, DO
OKC
OKC
OKC
INTERNAL MEDICINE OSHKOSH
FORT HOOD
Page 186 of 301
Disciplinary
Status Date
TX
AZ
P5012
8/15/2013
8/15/2018 NEUROLOGY
12/17/2012 12/17/2017 NEUROLOGY
12/17/2012 12/17/2017 NEUROLOGY
12/17/2012 12/17/2017 NEUROLOGY
NEUROLOGY &
12/1/2010
NEUROLOGY &
11/15/2011 11/15/2016 PSYCHIATRY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
PHOENIX
WARACH, STEVEN JAY, MD
11/4/2011
TX
EVANSVILLE
P1946
11/30/2012 11/30/2017 NEUROLOGY
Registration
Status of
Practice
Texas
State
License
1/23/2012 None
UNDER
BOARD
12/10/2012 ORDER
N/A
11/30/2012
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
KRISHNAMURTHY, GURUPRASAD ,
NEUROLOGY &
P6440
MD
5/1/2013
5/1/2018 PSYCHIATRY
NEUROLOGY/DIAGNO
STIC
RAD/NEURORADIOLO
P6664
KLAR, NITASHA GREWAL, MD
5/15/2013
5/15/2018 GY
NEUROMUSCULAR
N5943
PHAN, CECILE L., MD
4/9/2010
4/9/2015 DISEASE
NEUROMUSCULAR
P7207
SHARP, LYDIA JANE, MD
7/1/2013
7/1/2018 DISEASE
P5219
PAN, EDWARD, MD
1/4/2013
1/4/2018 NEURO-ONCOLOGY
P0669
SADIGHI, ZSILA SOUSAN, MD
8/1/2011
8/1/2016 NEURO-ONCOLOGY
NEUROPHYSIOLOGYN1706
KAWAI, MAKOTO , MD
12/12/2008 12/12/2013 NEUROLOGY
SUPSUPIN, EMILIO PATACSIL JR,
N5422
MD
2/5/2010
P7288
P2346
P0890
N4348
JACOB, ROY GEORGE, MD
PUTMAN, CHRISTOPHER MARK,
MD
AGARWAL, ANSHUL , MD
CHUANG, HUBERT , MD
P2997
HE, GUOCHENG DAVID, MD
5/1/2012
5/1/2017 NUCLEAR MEDICINE
N6388
JESSOP, AARON CRAIG, MD
6/4/2010
P1887
KIM, DO HEE, MD
1/17/2012
P6042
N1833
MOJTAHEDI, ALIREZA, MD
PENG, FANGYU , MD
N7164
7/15/2010
8/30/2013
6/3/2011
6/3/2016 OBSTETRICS
P6897
RAHMAN, SAIYYEDA , MD
YARBROUGH, TRACY LYNNETTE,
MD
PIERCE, BROCK LAWSON, MD
REESE-HOLLEY, MELODI NICHOLE,
MD
N9016
ACOSTA, OMETEOTL MIGUEL, MD
3/15/2011
P7872
N9932
7/15/2013
7/15/2018 NEURO-RADIOLOGY
3/1/2012
9/1/2011
11/6/2009
3/1/2017 NEURO-RADIOLOGY
Secondary Specialty
(Self-Designated)
PEDIATRICS
6/3/2018 OBSTETRICS
OBSTETRICS &
GYNECOLOGICAL
3/15/2016 SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
EL PASO
TX
ACTIVE
5/10/2013 None
N/A
AUSTIN
TX
ACTIVE
5/30/2013 None
N/A
NEUROLOGY
HOUSTON
TX
ACTIVE
4/26/2010 None
N/A
NEUROLOGY
NEUROLOGY
CHILD NEUROLOGY
DALLAS
DALLAS
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/8/2013 None
1/31/2013 None
8/5/2011 None
N/A
N/A
N/A
SLEEP MEDICINE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
12/17/2008 None
N/A
2/5/2010 None
N/A
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
DALLAS
TX
ACTIVE
7/17/2013 None
N/A
DALLAS
TX
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
4/16/2012 None
9/8/2011 None
11/17/2009 None
N/A
N/A
N/A
NUCLEAR IMAGING
AND THERAPY
NUCLEAR IMAGING
AND THERAPY
TX
ACTIVE
LICENSE
ISSUED
5/3/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/3/2012 None
N/A
4/1/2013 None
12/18/2008 None
N/A
N/A
7/15/2010 None
N/A
8/30/2013 None
6/16/2011 None
N/A
N/A
6/3/2013 None
N/A
3/18/2011 None
N/A
RADIOLOGY
FAMILY MEDICINE
4/1/2013
12/12/2008 12/12/2013 NUCLEAR MEDICINE
6/3/2013
Practice City
Registration
Status of
Practice
Texas
State
License
DALLAS
TX
FAMILY MEDICINE
MATERNAL AND
FETAL MEDICINE
Page 187 of 301
SAN ANTONIO TX
ACTIVE
License
Number
Physician Name
P5766
ADEYEMI, OLUYEMISI ADEDOYIN,
MD
N8477
ADEYEMO, ISHOLA SIKIRU, MD
N7201
AL-HOUSSEINI, ALI , MD
N4967
BURGE, TOVA LYNN, MD
N7247
DE LOS SANTOS, HUMBERTO
ANGEL, MD
N9846
DOYLE, NORA MARY, MD
P6168
GARNER, ERIN PAIGE, DO
P0827
GILLEN, ARIC CHRISTOPHER, MD
N7698
GILLESPIE, MARCIA ANN, MD
P7113
GONZALEZ, DELIA , MD
P7114
GOODWIN, JULIA, MD
N5087
GUDIPATY, MADHURI, MD
P0834
HODGES, KELLY R, MD
edicaid
edicaid
End Date
Designated)
OBSTETRICS &
GYNECOLOGICAL
3/15/2013
3/15/2018 SURGERY
OBSTETRICS &
GYNECOLOGICAL
1/18/2011
1/18/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
8/2/2010
8/2/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
2/5/2010
2/5/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
8/2/2010
8/2/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
6/3/2011
6/3/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
4/12/2013
4/12/2018 SURGERY
OBSTETRICS &
GYNECOLOGICAL
8/26/2011
8/26/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
9/15/2010
9/15/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
7/1/2013
7/1/2018 SURGERY
OBSTETRICS &
GYNECOLOGICAL
7/1/2013
7/1/2018 SURGERY
OBSTETRICS &
GYNECOLOGICAL
2/5/2010
2/5/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
8/26/2011
8/26/2016 SURGERY
Secondary Specialty
(Self-Designated)
OBSTETRICS AND
GYNECOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
Page 188 of 301
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
4/4/2013 None
N/A
BROOKLYN
NY
ACTIVE
2/14/2011 None
N/A
CORSICANA
TX
ACTIVE
8/18/2010 None
N/A
2/5/2010 None
N/A
OBSTETRICS AND
GYNECOLOGY
MATERNAL AND
FETAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
DALLAS
TX
ACTIVE
8/11/2010 None
N/A
TULSA
OK
ACTIVE
6/13/2011 None
N/A
ABILENE
TX
ACTIVE
4/17/2013 None
N/A
WACO
TX
LICENSE
ISSUED
8/26/2011 None
N/A
LICENSE
ISSUED
9/15/2010 None
N/A
AUSTIN
TX
ACTIVE
7/4/2013 None
N/A
DALLAS
TX
ACTIVE
7/9/2013 None
N/A
LICENSE
ISSUED
2/5/2010 None
N/A
LICENSE
ISSUED
8/26/2011 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
OBSTETRICS &
GYNECOLOGICAL
N6357
HODNETT, GEORGE MICHAEL, MD
6/4/2010
6/4/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N4481
HUDGINS, CHANNON TERIA , MD
11/6/2009
11/6/2014 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N6382
IWALOYE, FEMI DAVID, MD
6/4/2010
6/4/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
P1089
JUSTO, ANALIZA TENIDO, MD
10/3/2011
10/3/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
P6986
KATZ, KERRY, MD
6/14/2013
6/14/2018 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N7452
LITREL, MICHAEL JOSEPH, MD
8/16/2010
8/16/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N5212
MAGSINO, NANCY AGUILAR, MD
2/5/2010
2/5/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N7837
MARTINEZ, IVVANEE , MD
10/1/2010
10/1/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N8693
MOOLAMALLA, SURJIT REDDY, MD
2/4/2011
2/4/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N6504
MOORE, LEE DAVID, MD
6/4/2010
6/4/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N6508
MORENO, ARMIDA GALAVIZ, MD
6/4/2010
6/4/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N8963
OWOLABI, MICHAEL SANMI, MD
3/1/2011
3/1/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N1039
PANDYA, MAYANK , MD
8/29/2008
8/29/2013 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/4/2010 None
N/A
12/14/2009 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
LICENSE
ISSUED
10/3/2011 None
N/A
ACTIVE
7/2/2013 None
N/A
ACTIVE
9/23/2010 None
N/A
2/5/2010 None
N/A
10/4/2010 None
N/A
LICENSE
ISSUED
2/4/2011 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
OBSTETRICS AND
GYNECOLOGY
LICENSE
ISSUED
6/4/2010 None
N/A
OBSTETRICS AND
GYNECOLOGY
LICENSE
ISSUED
3/1/2011 None
N/A
ACTIVE
9/8/2008 None
N/A
ROCKWALL
TX
OBSTETRICS AND
GYNECOLOGY
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
GYNECOLOGY
Page 189 of 301
SAN ANTONIO TX
ACTIVE
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
OBSTETRICS &
GYNECOLOGICAL
N1051
PATHI, SUJATHA , MD
8/29/2008
8/29/2013 SURGERY
OBSTETRICS &
GYNECOLOGICAL
P3219
PAYNE, THOMAS, MD
5/15/2012
5/15/2017 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N5332
PERO, ROXANNE ELIZABETH, MD
2/5/2010
2/5/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
P1399
ROMEO, BRUNO A, MD
11/4/2011
11/4/2016 SURGERY
OBSTETRICS &
SAN JUAN, ARMANDO ABAD JR,
GYNECOLOGICAL
N5993
MD
4/9/2010
4/9/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
P6737
TRAN, THIEN VAN, MD
5/15/2013
5/15/2018 SURGERY
OBSTETRICS &
GYNECOLOGICAL
N9656
TSE, GLADYS, MD
5/2/2011
5/2/2016 SURGERY
OBSTETRICS &
VANDEPUTTE, NICHOLE
GYNECOLOGICAL
P2555
JEANETTA, MD
3/15/2012
3/15/2017 SURGERY
OBSTETRICS &
WILBURN-WREN, KRISTIE RENEE,
GYNECOLOGICAL
P4528
MD
9/17/2012
9/17/2017 SURGERY
ADEJANA, ADEGBOYEGA
OBSTETRICS AND
N2897
IBUKUNOLU, MD
5/29/2009
OBSTETRICS AND
N5522
ADLER, MICHAEL THOMAS, MD
4/9/2010
4/9/2015 GYNECOLOGY
OBSTETRICS AND
P0949
ALKALAY, AVISHAI ALBERT, MD
9/15/2011
OBSTETRICS AND
P2943
AMAN, ZARMINA, MD
5/1/2012
5/1/2017 GYNECOLOGY
OBSTETRICS AND
P6572
ANNAPURNA, VEERAYYAGARI, MD
5/15/2013
OBSTETRICS AND
N4253
ANTHONY, KERRI, MD
11/6/2009
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
9/24/2008 None
N/A
AUSTIN
TX
ACTIVE
5/17/2012 None
N/A
2/5/2010 None
SEE
PREVIOUS
11/4/2011 ORDER
N/A
LICENSE
ISSUED
Page 190 of 301
12/13/2011
ACTIVE
5/3/2010 None
N/A
TX
ACTIVE
5/20/2013 None
N/A
FORT WORTH TX
ACTIVE
5/16/2011 None
N/A
SAN ANTONIO TX
ACTIVE
3/26/2012 None
N/A
DALLAS
TX
ACTIVE
10/1/2012 None
N/A
BALTIMORE
MD
ACTIVE
LICENSE
ISSUED
10/21/2009 None
N/A
4/9/2010 None
N/A
9/20/2011 None
N/A
WICHITA
FALLS
MATERNAL AND
FETAL MEDICINE
Disciplinary
Status Date
DALLAS
LICENSE
ISSUED
OBSTETRICS AND
GYNECOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
BRONX
NY
ACTIVE
PLANO
TX
ACTIVE
LICENSE
ISSUED
5/4/2012 None
N/A
5/15/2013 None
N/A
ACTIVE
12/7/2009 None
N/A
MCALESTER
OK
License
Number
P0539
Physician Name
edicaid
edicaid
End Date
Designated)
8/1/2011
N8608
ARGOTI, PEDRO SALVADOR, MD
ASAJU, SUNDAY OLANREWAJU,
MD
N9804
ATWAL, MANINDERJIT KAUR, MD
6/3/2011
2/4/2011
OBSTETRICS AND
8/1/2016 GYNECOLOGY
OBSTETRICS AND
2/4/2016 GYNECOLOGY
OBSTETRICS AND
6/3/2016 GYNECOLOGY
N6154
AZAM, GHAZALA AHMED, MD
6/4/2010
6/4/2015
P6135
BAILEY, ELIZABETH ANN, MD
4/12/2013
4/12/2018
N4282
BAREKET, HENRY ZVI, MD
11/6/2009
11/6/2014
P2416
BELTRAMINI, ERIN WEUST, DO
3/15/2012
3/15/2017
P6141
BEVAN, CATHERINE IRENE, MD
4/12/2013
4/12/2018
P6338
BILLUE, DAVID CLAYTON, MD
5/1/2013
5/1/2018
P1728
BIRKHOLZ, CHRISTOPHER , MD
1/2/2012
1/2/2017
N4951
BOGAN, TIFFANY N, MD
2/5/2010
2/5/2015
P2959
BOLT, KATHERINE , MD
5/1/2012
5/1/2017
N9026
BRAKOVEC, JENNY LEE, MD
BRIGGER, KRISTIN ROGGENKAMP,
MD
3/15/2011
3/15/2016
4/9/2010
4/9/2015
N5591
N1566
N4964
BROWNE, CATHERINE P., DO
BROWNING, ADRIANNE CONES,
MD
P2203
BROZENA, KRISTIN , MD
12/12/2008 12/12/2013
2/5/2010
2/5/2015
3/1/2012
3/1/2017
P7613
BUI, CINDY-THANHHOA HUYNH,
MD
8/15/2013
N2970
BULLOCK, NICOLE CHRISTINE , DO
5/29/2009
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 191 of 301
8/9/2011 None
N/A
2/4/2011 None
N/A
6/3/2011 None
N/A
6/4/2010 None
N/A
4/12/2013 None
N/A
ACTIVE
1/11/2010 None
N/A
ACTIVE
3/23/2012 None
N/A
ACTIVE
4/18/2013 None
N/A
ACTIVE
5/9/2013 None
N/A
ACTIVE
LICENSE
ISSUED
1/6/2012 None
N/A
2/5/2010 None
N/A
ACTIVE
5/3/2012 None
N/A
ACTIVE
3/22/2011 None
N/A
ACTIVE
4/27/2010 None
N/A
ACTIVE
LICENSE
ISSUED
1/5/2009 None
N/A
2/5/2010 None
N/A
SAN ANTONIO TX
ACTIVE
3/8/2012 None
N/A
LUBBOCK
TX
ACTIVE
8/20/2013 None
N/A
MANSFIELD
TX
ACTIVE
6/12/2009 None
N/A
NY
DALLAS
TX
GUNTERSVILL
E
AL
TEMPLE
OBSTETRICS
Disciplinary
Status Date
LICENSE
ISSUED
LICENSE
ISSUED
SUFFERN
OBSTETRICS AND
GYNECOLOGY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
CONROE
TX
TX
License
Number
N9521
P4634
Physician Name
BURKETT, DANIELLE, DO
BURNEY, JOHN MARCEL JAMES,
MD
P4936
BYRD, TERESA T, MD
N2979
CARRENO, CARLOS ALBERTO, MD
N3559
CHIOSSI, GIUSEPPE , MD
P3301
CHONG, MICHELLE , MD
P2619
CHU, ETEM TABOGHO, MD
N8284
CHUMBLEY, CLYDE MARION II, MD
CHUNG, CHRISTOPHER PEI-CHIA,
MD
COLVIN, BRADLEY CHRISTOPHER,
MD
COMPTON-JOSEPH, BRANDI
ANTOINETTE, MD
N4988
P6802
P3524
edicaid
edicaid
End Date
Designated)
OBSTETRICS AND
5/2/2011
5/2/2016 GYNECOLOGY
OBSTETRICS AND
10/15/2012 10/15/2017 GYNECOLOGY
OBSTETRICS AND
11/30/2012 11/30/2017 GYNECOLOGY
OBSTETRICS AND
5/29/2009
OBSTETRICS AND
8/21/2009
OBSTETRICS AND
6/1/2012
6/1/2017 GYNECOLOGY
OBSTETRICS AND
4/2/2012
4/2/2017 GYNECOLOGY
OBSTETRICS AND
12/15/2010 12/15/2015 GYNECOLOGY
OBSTETRICS AND
2/5/2010
2/5/2015 GYNECOLOGY
OBSTETRICS AND
6/3/2013
6/3/2018 GYNECOLOGY
OBSTETRICS AND
6/8/2012
6/8/2017 GYNECOLOGY
OBSTETRICS AND
3/1/2011
3/1/2016 GYNECOLOGY
OBSTETRICS AND
4/12/2013
OBSTETRICS AND
8/15/2011
N8899
CONNEALY, BRENDAN DANIEL, MD
P6153
DABIRI, TAJUDEEN O, MD
P0716
DANDAN, MELHEM, MD
P0366
DAO, MINH DUY, MD
N8288
DAVID, ROCHELLE MARIE, MD
P0570
DAVIS, GLENA JUNE, DO
8/1/2011
N3603
DAVIS, RACHEL ANN, MD
8/21/2009
P5792
DAY, CEDRIC TARRYL JR, MD
3/15/2013
7/15/2011
12/15/2010
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
8/1/2016 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
MATERNAL AND
FETAL MEDICINE
MATERNAL AND
FETAL MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
MAYWOOD
IL
ACTIVE
5/24/2011 None
N/A
LONGVIEW
TX
ACTIVE
10/19/2012 None
N/A
LICENSE
ISSUED
11/30/2012 None
N/A
HOUSTON
TX
ACTIVE
6/3/2009 None
N/A
GALVESTON
TX
ACTIVE
9/1/2009 None
N/A
ACTIVE
6/5/2012 None
N/A
ACTIVE
4/11/2012 None
N/A
12/23/2010 None
N/A
2/5/2010 None
N/A
7/8/2013 None
N/A
TAYLOR
TX
UROGYNECOLOGY
ACTIVE
LICENSE
ISSUED
SHREVEPORT LA
ACTIVE
HOUSTON
ACTIVE
LICENSE
ISSUED
6/13/2012 None
N/A
3/1/2011 None
N/A
ACTIVE
4/19/2013 None
N/A
ACTIVE
8/22/2011 None
N/A
ACTIVE
7/22/2011 None
N/A
SAN ANTONIO TX
MINERAL
WELLS
TX
ACTIVE
12/23/2010 None
N/A
ACTIVE
8/5/2011 None
N/A
HUMBLE
TX
ACTIVE
8/31/2009 None
N/A
TEMPLE
TX
ACTIVE
3/20/2013 None
N/A
TX
MATERNAL AND
FETAL MEDICINE
KILLEEN
TX
FAMILY MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 192 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
P5960
DELUKIE, ALEIGHA ANN, DO
N7533
DENNIS, RONNIE WAYNE, MD
P7267
DERMISH, AMNA IBRAHIM, MD
P4944
DEW, LAUREN ASHLEY, MD
edicaid
edicaid
End Date
Designated)
OBSTETRICS AND
4/1/2013
4/1/2018 GYNECOLOGY
OBSTETRICS AND
8/27/2010
OBSTETRICS AND
7/15/2013
OBSTETRICS AND
11/30/2012 11/30/2017 GYNECOLOGY
P0196
DIAGNE, THIENDELLA, MD
7/1/2011
P5968
DOMINGUEZ, AURORA, MD
4/1/2013
N8644
DOSS, JOHN RICHARD, MD
2/4/2011
N2476
4/3/2009
N5026
DREVER, NATHAN SCOTT, MD
DURET-UZODINMA, JENNY JEANJULIEN, MD
P7103
DUTTA, ERYN HART, DO
7/1/2013
N5031
EGU, OBILOH ENYINNAYA , MD
2/5/2010
P6610
EHLERS, KARA A, MD
N1314
ELHAMMADY, ESLAM , MD
N4395
ELLIS, PATRICK ANDREWS, MD
P4568
ELMAZI, FUNDIME , DO
N8911
ENGGANO, BRIAN MATTHEW, MD
P1455
N7253
ERWIN, JAMIE LIN WALKER, MD
ESIELY, MOHAMED ABDELHADY,
MD
N5890
EYE, RITA ELLEN, MD
2/5/2010
5/15/2013
10/10/2008
11/6/2009
10/1/2012
3/1/2011
11/15/2011
8/2/2010
4/9/2010
OBSTETRICS AND
7/1/2016 GYNECOLOGY
OBSTETRICS AND
4/1/2018 GYNECOLOGY
OBSTETRICS AND
2/4/2016 GYNECOLOGY
OBSTETRICS AND
4/3/2014 GYNECOLOGY
OBSTETRICS AND
2/5/2015 GYNECOLOGY
OBSTETRICS AND
7/1/2018 GYNECOLOGY
OBSTETRICS AND
2/5/2015 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
3/1/2016 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
8/2/2015 GYNECOLOGY
OBSTETRICS AND
4/9/2015 GYNECOLOGY
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
MATERNAL AND
FETAL MEDICINE
MATERNAL AND
FETAL MEDICINE
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TEMPLE
SWEETWATE
R
TX
ACTIVE
4/10/2013 None
N/A
TX
ACTIVE
9/13/2010 None
N/A
AUSTIN
TX
ACTIVE
7/26/2013 None
N/A
DALLAS
TX
ACTIVE
12/14/2012 None
N/A
EDINBURG
TX
ACTIVE
LICENSE
ISSUED
8/3/2011 None
N/A
4/1/2013 None
N/A
2/9/2011 None
N/A
HOPE
AR
ACTIVE
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
4/22/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/9/2013 None
N/A
2/5/2010 None
N/A
GALVEVSTON TX
DALLAS
TX
ACTIVE
5/27/2013 None
N/A
COLUMBUS
TX
ACTIVE
10/29/2008 None
N/A
ACTIVE
11/16/2009 None
N/A
ACTIVE
10/8/2012 None
N/A
ACTIVE
3/14/2011 None
N/A
ACTIVE
11/18/2011 None
N/A
ACTIVE
9/22/2010 None
N/A
ACTIVE
5/3/2010 None
N/A
AUSTIN
TULSA
Page 193 of 301
Registration
Status of
Practice
Texas
State
License
TX
OK
License
Number
P1995
Physician Name
edicaid
edicaid
End Date
Designated)
2/1/2012
2/1/2017
N9543
EZZATI, MOHAMMAD, MD
FADAHUNSI, TITILOLA
OLUJUMOKE, MD
5/2/2011
5/2/2016
N9853
FARO, JONATHAN PAUL, MD
6/3/2011
6/3/2016
N8507
FAY, KARI H, MD
1/18/2011
1/18/2016
P3321
FILETTI, LUSIA CRISTINA, MD
P6164
FORBES, JOANNA , MD
6/1/2012
4/12/2013
N4415
FRIEL, LARA ANNE , MD
11/6/2009
P1307
GARDA, JACQUELINE LABOE, DO
11/4/2011
N1647
GILLMAN, NICOLE , MD
P3628
GODLEY, STACEY ALECE, MD
N7925
GONZALEZ, MANDY MARIE, MD
10/15/2010
P1316
GRANDE, KATHRYN BURNS, MD
11/4/2011
N0805
GREWAL, PREETPAL , DO
8/29/2008
P3160
GRIFFIN, STEPHEN JOHN, MD
5/15/2012
12/12/2008
6/15/2012
N7269
GROENING-WANG, MARY TRACI,
DO
8/2/2010
P5636
GRUBBS, CHRISTINA DANIEL, MD
3/1/2013
N5088
GULICK, JENNIFER ROSE, MD
2/5/2010
P1871
HA, THOA KIM, MD
1/17/2012
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
8/2/2015 GYNECOLOGY
OBSTETRICS AND
3/1/2018 GYNECOLOGY
OBSTETRICS AND
2/5/2015 GYNECOLOGY
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
REPRODUCTIVE
ENDOCRINOLOGY
AND INFERTILITY
Practice City
Registration
Status of
Practice
Texas
State
License
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 194 of 301
Disciplinary
Status Date
DALLAS
TX
ACTIVE
2/17/2012 None
N/A
MCKINNEY
TX
ACTIVE
5/9/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
6/14/2011 None
N/A
1/18/2011 None
N/A
6/1/2012 None
N/A
OBSTETRICS &
GYNECOLOGICAL
SURGERY
MATERNAL AND
FETAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
DALLAS
TX
ACTIVE
4/18/2013 None
N/A
HOUSTON
TX
ACTIVE
11/16/2009 None
N/A
FT. WORTH
TX
ACTIVE
11/15/2011 None
N/A
PASADENA
TX
ACTIVE
2/10/2009 None
N/A
SPRING
TX
ACTIVE
LICENSE
ISSUED
6/27/2012 None
N/A
10/15/2010 None
N/A
DALLAS
TX
ACTIVE
12/15/2011 None
N/A
EL PASO
TX
ACTIVE
9/5/2008 None
N/A
AMARILLO
TX
ACTIVE
5/17/2012 None
N/A
EL PASO
TX
ACTIVE
8/23/2010 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
3/5/2013 None
N/A
2/5/2010 None
N/A
2/23/2012 None
N/A
DALLAS
TX
ACTIVE
License
Number
Physician Name
N1669
HANNA, SABRINA ANN, MD
N6342
HANSEN, CATHERINE ANNE, MD
P2995
HAPPE, SARAH KATHLEEN, MD
edicaid
edicaid
End Date
Designated)
OBSTETRICS AND
12/12/2008 12/12/2013 GYNECOLOGY
OBSTETRICS AND
6/4/2010
6/4/2015 GYNECOLOGY
OBSTETRICS AND
5/1/2012
5/1/2017 GYNECOLOGY
N5715
HATTON, AMANDA , MD
4/9/2010
P6826
HAWASLY, KINAN, MD
6/3/2013
N6885
HAWKINS, TRONYA NYCHOLL, MD
7/1/2010
P5814
HAYGOOD-KANE, T LYNNE, DO
N5721
P1184
HEAPS, BRIAN RICHARD, MD
HENRY-DACOSTA, NICOLE
DANEEL, DO
N9454
HERMANN, CYNTHIA DEAL, MD
3/15/2013
OBSTETRICS AND
4/9/2015 GYNECOLOGY
OBSTETRICS AND
10/17/2011 10/17/2016 GYNECOLOGY
OBSTETRICS AND
4/15/2011
4/9/2010
P6634
HICE-GARZA, JARMARA
LAURETTE, MD
N6360
HOLLINGSWORTH, AMANDA, DO
6/4/2010
P3002
HOLMES, AMIE ELIZABETH, MD
5/1/2012
N6888
HOUSTON, LAURA MARIE, MD
7/1/2010
N6375
IKEDA, MARCOS HIROSHI, MD
6/4/2010
5/15/2013
P6832
IMGRUND, KATHRYN HAWKINS,
MD
6/3/2013
N2576
IQBAL, SAYEED NURUL, MD
4/3/2009
P5385
JACKSON, TIFFANY RHEA, MD
OBSTETRICS AND
4/9/2015 GYNECOLOGY
OBSTETRICS AND
6/3/2018 GYNECOLOGY
OBSTETRICS AND
7/1/2015 GYNECOLOGY
OBSTETRICS AND
2/1/2013
OBSTETRICS AND
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
5/1/2017 GYNECOLOGY
OBSTETRICS AND
7/1/2015 GYNECOLOGY
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
6/3/2018 GYNECOLOGY
OBSTETRICS AND
4/3/2014 GYNECOLOGY
OBSTETRICS AND
2/1/2018 GYNECOLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ROUND ROCK TX
DALLAS
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
GYNECOLOGIC
SURGERY
Page 195 of 301
Disciplinary
Status Date
2/9/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
6/22/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/26/2010 None
N/A
6/3/2013 None
N/A
7/1/2010 None
N/A
HENDERSON
TX
ACTIVE
3/21/2013 None
N/A
SUGAR LAND
TX
ACTIVE
4/30/2010 None
N/A
LAREDO
TX
ACTIVE
LICENSE
ISSUED
11/10/2011 None
N/A
4/15/2011 None
N/A
6/12/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
5/11/2012 None
N/A
ACTIVE
LICENSE
ISSUED
7/12/2010 None
N/A
6/4/2010 None
N/A
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
GENERAL PRACTICE FORT WORTH TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
TYLER
TX
ACTIVE
6/21/2013 None
N/A
CHICAGO
IL
ACTIVE
5/8/2009 None
N/A
ACTIVE
2/5/2013 None
N/A
CELEBRATION FL
License
Number
Physician Name
P6836
JEMELKA, BROOKE ELAINE, MD
N5747
JOHNSON, CHERIE JEANNE, MD
N5148
KARBAN, IRINA, DO
N9881
KASPER, MEGAN ELIZABETH, MD
P6006
KAUFMAN, CAROLINE , MD
P3180
KISTLER, ANNALIESE ELAINE, MD
P2712
KUNG, AMY , MD
N9584
KWAN, NATHAN ANDREW, MD
P6206
LANDHERR, KATHRYN M, MD
K6640
LEDLEY, ANNMARIE MCRENA, DO
N9728
LEE, TANIA MONGE, MD
N5807
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
6/3/2013
6/3/2018 GYNECOLOGY
OBSTETRICS AND
MATERNAL AND
4/9/2010
4/9/2015 GYNECOLOGY
FETAL MEDICINE
OBSTETRICS AND
2/5/2010
2/5/2015 GYNECOLOGY
OBSTETRICS AND
6/3/2011
6/3/2016 GYNECOLOGY
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
4/1/2013
4/1/2018 GYNECOLOGY
SURGERY
OBSTETRICS AND
5/15/2012
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
4/2/2012
4/2/2017 GYNECOLOGY
SURGERY
OBSTETRICS AND
5/2/2011
5/2/2016 GYNECOLOGY
OBSTETRICS AND
4/12/2013
2/6/2009
OBSTETRICS AND
2/6/2014 GYNECOLOGY
5/16/2011
5/16/2016
LEWIS, DAWN RENEE, MD
4/9/2010
4/9/2015
P6448
LIMAS, FLOR AURORA, MD
5/1/2013
5/1/2018
P0082
LINDO, FIONA M, MD
6/15/2011
6/15/2016
P6449
LOPEZ, SANDRA , MD
5/1/2013
5/1/2018
P7153
LUNA, RENE IMMANUEL, MD
7/1/2013
7/1/2018
N8030
LYON, ALBERT WILFRED, MD
LYONS GAFFANEY, CECILIA
ANNSOFI, MD
N9256
10/29/2010 10/29/2015
4/1/2011
4/1/2016
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
Practice City
HOUSTON
CORPUS
CHRISTI
DALHART
AUSTIN
KILLEEN
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
TX
TX
TX
GREENVILLE
TX
LEWISTON
ME
MATERNAL AND
FETAL MEDICINE
Page 196 of 301
N/A
ACTIVE
LICENSE
ISSUED
4/26/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
6/15/2011 None
N/A
ACTIVE
4/11/2013 None
N/A
ACTIVE
5/23/2012 None
N/A
LICENSE
ISSUED
4/2/2012 None
N/A
ACTIVE
5/5/2011 None
N/A
N/A
ACTIVE
4/23/2013 None
SEE
PREVIOUS
3/10/2009 ORDER
ACTIVE
5/24/2011 None
N/A
ACTIVE
4/28/2010 None
N/A
5/3/2013 None
N/A
6/15/2011 None
N/A
5/8/2013 None
N/A
7/11/2013 None
N/A
10/29/2010 None
N/A
4/7/2011 None
N/A
ACTIVE
LICENSE
ISSUED
UROGYNECOLOGY
EL PASO
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
CAMPBELL
CA
Disciplinary
Status Date
6/6/2013 None
ACTIVE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
2/3/2006
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
OBSTETRICS AND
P7154
MAKINDE, EDILEOLA, MD
7/1/2013
7/1/2018 GYNECOLOGY
MALDONADO, PEDRO ANTONIO,
OBSTETRICS AND
P6455
MD
5/1/2013
5/1/2018 GYNECOLOGY
OBSTETRICS AND
N5218
MANDALAPU, VIJAYA LAKSHMI, MD
2/5/2010
2/5/2015 GYNECOLOGY
OBSTETRICS AND
N5221
MARCELLO, ALTON , MD
2/5/2010
2/5/2015 GYNECOLOGY
OBSTETRICS AND
P3648
MARKS, LATOIA MONNEQUE, MD
6/15/2012
OBSTETRICS AND
P5206
MARKS, SONYA DENISE, MD
1/4/2013
1/4/2018 GYNECOLOGY
P2488
MASON, SHAUNNA TORRANCE,
MD
3/15/2012
P1896
MCCAIN, FRANCINE FRASER, MD
1/17/2012
P7506
MCKENZIE, KRISTI HAMILTON, MD
8/1/2013
P5842
MENDEZ-FIGUEROA, HECTOR, MD
N6493
MILLAN, LIZ PAULINA, MD
6/4/2010
P5687
MILOV, SEVA, MD
3/1/2013
P5843
MISRA, NEETI V, MD
P5425
MITRO, JOSEPH CALEB, MD
3/15/2013
3/15/2013
2/1/2013
N7313
MOHAMMED, HUMERA , MD
8/2/2010
N6501
MOMENI, MAZDAK , MD
MONTOYA, TEODORO IGNACIO,
MD
6/4/2010
N5879
N2198
MOOLA, SUNITA , MD
4/9/2010
2/6/2009
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
8/1/2018 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
3/1/2018 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
2/1/2018 GYNECOLOGY
OBSTETRICS AND
8/2/2015 GYNECOLOGY
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
4/9/2015 GYNECOLOGY
OBSTETRICS AND
2/6/2014 GYNECOLOGY
Secondary Specialty
(Self-Designated)
UROGYNECOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
MD
ACTIVE
8/7/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
5/8/2013 None
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
6/15/2012 None
N/A
ACTIVE
2/11/2013 None
N/A
3/15/2012 None
N/A
1/17/2012 None
N/A
GENERAL PRACTICE
OBSTETRICS AND
GYNECOLOGY
HOUSTON
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
LICENSE
ISSUED
LICENSE
ISSUED
AUSTIN
TX
ACTIVE
8/2/2013 None
N/A
HOUSTON
TX
ACTIVE
4/5/2013 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
EHT
NJ
ACTIVE
3/12/2013 None
N/A
FREEHOLD
NJ
ACTIVE
LICENSE
ISSUED
3/21/2013 None
N/A
2/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
8/12/2010 None
N/A
6/4/2010 None
N/A
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 197 of 301
Disciplinary
Status Date
BALTIMORE
UROGYNECOLOGY
MATERNAL AND
FETAL MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
EL PASO
TX
ACTIVE
4/27/2010 None
N/A
LAS CRUCES
NM
ACTIVE
3/16/2009 None
N/A
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
P2147
MOORE, GRADIE ELIZABETH, MD
2/10/2012
OBSTETRICS AND
N6507
MOOSA, AZEEMA, MD
6/4/2010
6/4/2015 GYNECOLOGY
OBSTETRICS
OBSTETRICS AND
P0256
MOSU, NICOLAE, MD
7/1/2011
7/1/2016 GYNECOLOGY
OBSTETRICS AND
P1112
MUGHRABI, LINDA BASSAM, MD
10/3/2011
OBSTETRICS AND
N6518
NABORS, VENUS JOLLY, MD
6/4/2010
6/4/2015 GYNECOLOGY
OBSTETRICS AND
N9753
NAGY, SZILVIA, MD
5/16/2011
OBSTETRICS AND
N8825
NARVAEZ, JUAN CARLOS, MD
2/15/2011
OBSTETRICS AND
P2904
NIEMAND, NOELLE ROSE, MD
4/13/2012
OBSTETRICS AND
P0861
NORSWORTHY, TWYLA NASH, MD
8/26/2011
OBSTETRICS AND
P7323
NORTHROP, SARA CHRISTINE, DO
7/15/2013
OLOWOOKERE, AYODELE
OBSTETRICS AND
N4638
OLAWALE, MD
11/6/2009
OBSTETRICS AND
P6486
OMMANI, SOPHIA JOSEFINA, MD
5/1/2013
5/1/2018 GYNECOLOGY
OBSTETRICS AND
P1379
ORNELAS, JACOB D, MD
11/4/2011
OBSTETRICS AND
P0648
OWENSBY, TRACEY LYNN, MD
8/1/2011
8/1/2016 GYNECOLOGY
OBSTETRICS AND
N2227
PADILLA-WILLIAMS, LILIANA, MD
2/6/2009
2/6/2014 GYNECOLOGY
OBSTETRICS AND
MATERNAL AND
N9479
PARKER, ASHLEY NICOLE, MD
4/15/2011
FETAL MEDICINE
OBSTETRICS AND
N8235
PARKER, JOHN ROBERT, MD
12/1/2010
OBSTETRICS AND
P7181
PATEL, BIMAL RAMAN, DO
7/1/2013
7/1/2018 GYNECOLOGY
OBSTETRICS AND
P1577
PATEL, POOJA RANI, MD
12/1/2011
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
P5706
PECK, MARIANNE BERGQUIST, MD
3/1/2013
3/1/2018 GYNECOLOGY
SURGERY
Page 198 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
2/14/2012 None
N/A
6/4/2010 None
N/A
JAMAICA
NY
ACTIVE
7/25/2011 None
N/A
HENDERSON
TX
ACTIVE
LICENSE
ISSUED
10/5/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/19/2011 None
N/A
2/15/2011 None
N/A
4/13/2012 None
N/A
SAN ANTONIO TX
MAGNOLIA
AR
ACTIVE
9/6/2011 None
N/A
MANSFIELD
TX
ACTIVE
7/18/2013 None
N/A
CINCINNATI
CORPUS
CHRISTI
OH
ACTIVE
11/20/2009 None
N/A
TX
ACTIVE
7/9/2013 None
N/A
LUBBOCK
TX
12/8/2011 None
N/A
HARLINGEN
TX
ACTIVE
LICENSE
ISSUED
8/1/2011 None
N/A
MCALLEN
TX
ACTIVE
2/17/2009 None
N/A
SAN ANTONIO TX
ACTIVE
4/21/2011 None
N/A
COLUMBUS
OH
ACTIVE
12/6/2010 None
N/A
FORT WORTH TX
ACTIVE
7/15/2013 None
N/A
ACTIVE
1/2/2012 None
N/A
LICENSE
ISSUED
3/1/2013 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P7535
PEREZ RODRIGUEZ, OMAR, MD
8/1/2013
N6579
PETTY, JOSEPH L, MD
6/4/2010
P2342
PIERSON, SERENA MICHELLE, MD
3/1/2012
P7539
PIPARIA, MAANSI, MD
8/1/2013
N7573
PRADERIO, CAROLINA, MD
N6588
PUIG, CARLOS EDUARDO, MD
P7835
PULLANO, JAMES GEORGE, MD
P4696
N6968
RABSATT, LATASHA ALEXIS, MD
RAC, MARTHA WATTINE FRAZIER,
MD
P7338
RAMIREZ, ELIZABETH ANN, MD
8/27/2010
6/4/2010
8/30/2013
10/15/2012
7/1/2010
7/15/2013
OBSTETRICS AND
8/1/2018 GYNECOLOGY
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
3/1/2017 GYNECOLOGY
OBSTETRICS AND
8/1/2018 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
7/1/2015 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
12/12/2008 12/12/2013 GYNECOLOGY
P0866
RAMIREZ, ORLANDO MANUEL, MD
8/26/2011
N1846
RAMSEY, PATRICK SHANNON, MD
P1810
REDDY, SIREESHA YERRADHODDI,
MD
N4694
REDDY, SOWMYA, MD
P7192
REKHI, JASWINDER, DO
7/1/2013
P2351
REYNOLDS, MARION ARLEEN, MD
3/1/2012
P6709
RHOADES, COURTNEY PAIGE, DO
5/15/2013
P1812
RIOS PEREZ, JIMMI, MD
1/2/2012
P3426
RIVERA JIMENEZ, JOEL R, MD
6/1/2012
1/2/2012
11/6/2009
OBSTETRICS AND
1/2/2017 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
7/1/2018 GYNECOLOGY
OBSTETRICS AND
3/1/2017 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
1/2/2017 GYNECOLOGY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
MATERNAL AND
FETAL MEDICINE
Practice City
LAREDO
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
8/5/2013 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
4/16/2012 None
N/A
AUSTIN
CORPUS
CHRISTI
TX
ACTIVE
8/2/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
9/8/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
9/5/2013 None
N/A
ACTIVE
10/22/2012 None
N/A
ACTIVE
7/23/2010 None
N/A
TX
ACTIVE
7/30/2013 None
N/A
BROWNSVILL
E
TX
ACTIVE
8/31/2011 None
N/A
SAN ANTONIO TX
ACTIVE
4/21/2009 None
N/A
EL PASO
ACTIVE
1/12/2012 None
N/A
ACTIVE
2/1/2010 None
N/A
ACTIVE
8/7/2013 None
N/A
ACTIVE
3/5/2012 None
N/A
ACTIVE
LICENSE
ISSUED
6/4/2013 None
N/A
1/2/2012 None
N/A
ACTIVE
6/8/2012 None
N/A
SUGAR LAND
LAKE
JACKSON
MCALLEN
Page 199 of 301
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
DALLAS
OBSTETRICS &
GYNECOLOGICAL
SURGERY
MATERNAL AND
FETAL MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
GYNECOLOGY
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
TX
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
OBSTETRICS AND
N6973
RODE, ANURADHA SANJAY, MD
7/1/2010
7/1/2015 GYNECOLOGY
OBSTETRICS AND
N3276
RODRIGUEZ, CELSO ANTONIO, MD
5/29/2009
N6623
RODRIGUEZ, JOSEPH ANTHONY,
MD
6/4/2010
P0284
RODRIGUEZ, LORNA, MD
7/1/2011
P1689
ROLAND, CYNTHIA RENEE, MD
N6980
RUGER, ERICA PATRICE, MD
RUTZ, JOSEPH ALEXANDER JR,
MD
P1813
12/15/2011
7/1/2010
1/2/2012
P6070
SAAD, ANTONIO , MD
4/1/2013
P3436
SAN MARTIN, JOSE EDUARDO, MD
6/1/2012
P0929
SATCHO, HONORE, MD
9/1/2011
P1489
SAYEGH, GILBERT GEORGE, MD
N9410
SCHIEMENZ, APRIL ANN, MD
P3072
SEHGAL, MONICA, MD
P1693
SEIVWRIGHT, TRUDY LECEIN, MD
N8726
SIDHU, JASPREET SINGH, MD
E6917
SIGMAN, ROBERT KARL, MD
N1151
SMITH, ALLISON LEIGH, MD
P5731
SMITH, JOY MONICA, MD
P2532
SMITH, LAUREN QUIRK, MD
11/15/2011
4/8/2011
5/1/2012
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
7/1/2016 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
7/1/2015 GYNECOLOGY
OBSTETRICS AND
1/2/2017 GYNECOLOGY
OBSTETRICS AND
4/1/2018 GYNECOLOGY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
OBSTETRICS AND
9/1/2016 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
4/8/2016 GYNECOLOGY
OBSTETRICS AND
5/1/2017 GYNECOLOGY
OBSTETRICS AND
12/15/2011 12/15/2016 GYNECOLOGY
OBSTETRICS AND
2/4/2011
2/4/2016 GYNECOLOGY
OBSTETRICS AND
10/17/2011 10/17/2016 GYNECOLOGY
OBSTETRICS AND
8/29/2008
OBSTETRICS AND
3/1/2013
3/1/2018 GYNECOLOGY
OBSTETRICS AND
3/15/2012
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
MATERNAL AND
FETAL MEDICINE
Registration
Status of
Practice
Texas
State
License
IL
ACTIVE
7/15/2010 None
N/A
HOUSTON
TX
ACTIVE
6/3/2009 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
7/29/2011 None
N/A
12/19/2011 None
N/A
7/1/2010 None
N/A
ARLINGTON
TX
ACTIVE
BASTROP
LA
ACTIVE
1/12/2012 None
N/A
GALVESTON
TX
ACTIVE
4/12/2013 None
N/A
ACTIVE
LICENSE
ISSUED
6/5/2012 None
N/A
9/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
11/21/2011 None
N/A
4/8/2011 None
N/A
FAMILY PRACTICE
WHARTON
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
MATERNAL AND
FETAL MEDICINE
Page 200 of 301
Disciplinary
Status Date
Practice City
ELK GROVE
VILLAGE
ACTIVE
LICENSE
ISSUED
MATERNAL AND
FETAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
MARSHALL
TX
ACTIVE
5/3/2012 None
N/A
ROSWELL
NM
ACTIVE
12/22/2011 None
N/A
ATHENS
TX
ACTIVE
2/15/2011 None
N/A
FORT WORTH TX
ACTIVE
10/28/2011 None
N/A
DALLAS
TX
ACTIVE
9/16/2008 None
N/A
DALLAS
TX
ACTIVE
3/20/2013 None
N/A
TEMPLE
TX
ACTIVE
3/20/2012 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
OBSTETRICS AND
N2815
SMITH, SHARON ALTHEA , MD
4/3/2009
4/3/2014 GYNECOLOGY
OBSTETRICS AND
N2818
SMITH-SHAM, STEPHANIE DEE, MD
4/3/2009
4/3/2014 GYNECOLOGY
OBSTETRICS AND
N6675
SOKKARY, NANCY A, MD
6/4/2010
6/4/2015 GYNECOLOGY
OBSTETRICS AND
P7355
SOTO, ELEAZAR EDUARDO, MD
7/15/2013
STEVENS, CHRISTOPHER
OBSTETRICS AND
N9965
BARNETT, MD
6/3/2011
6/3/2016 GYNECOLOGY
OBSTETRICS AND
N3333
STREET, REAGAN MICHELLE, MD
5/29/2009
OBSTETRICS AND
N1464
SUNDARAM, SUBHA , MD
10/10/2008 10/10/2013 GYNECOLOGY
OBSTETRICS AND
N7497
SWANSON, OLGA FLOMIN, MD
8/16/2010
N5424
SZYLLER, ALAIN HERBERT, MD
2/5/2010
N6059
TAN, ORKUN, MD
4/9/2010
P7041
TASSONE, SHAWN ANTHONY, MD
P3593
TAYLOR, KRISTAL , MD
P4912
THOMAS, SALY, MD
TOMLINSON, TRACY MICHELLE,
MD
MD
MD
P5140
P5140
P5140
P7864
TORRES, MARIA C, MD
P1702
TOUADROUS, AMEER, MD
6/14/2013
6/8/2012
11/15/2012
12/17/2012
12/17/2012
12/17/2012
OBSTETRICS AND
2/5/2015 GYNECOLOGY
OBSTETRICS AND
4/9/2015 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
6/8/2017 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
12/15/2011 12/15/2016 GYNECOLOGY
8/30/2013
Secondary Specialty
(Self-Designated)
MATERNAL AND
FETAL MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
4/10/2009 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
5/11/2009 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
8/15/2013 None
N/A
FORT WORTH TX
ACTIVE
6/13/2011 None
N/A
GALVESTON
ACTIVE
6/9/2009 None
N/A
ACTIVE
10/20/2008 None
N/A
ACTIVE
9/3/2010 None
N/A
LICENSE
ISSUED
2/5/2010 None
N/A
LICENSE
ISSUED
4/9/2010 None
N/A
HOUSTON
TX
GALVESTON
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
REPRODUCTIVE
ENDOCRINOLOGY
AND INFERTILITY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 201 of 301
Disciplinary
Status Date
HOUSTON
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
AUSTIN
TX
ACTIVE
6/18/2013 None
N/A
HOUSTON
TX
ACTIVE
6/19/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
11/23/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
ACTIVE
9/5/2013 None
N/A
ACTIVE
2/27/2012 None
N/A
VICTORIA
TX
License
Number
N9319
Physician Name
TOVAR, MIGUEL ANGEL, DO
edicaid
edicaid
End Date
Designated)
OBSTETRICS AND
4/1/2011
4/1/2016 GYNECOLOGY
P0146
TUCKER, KEELIE RENEE, MD
N6730
TUDELA, CARMEN M, MD
6/4/2010
N6739
URRUTIA, ALLISON ANNE, MD
6/4/2010
P1425
VAN HORNE, ANNE, MD
11/4/2011
P6742
VAN WINKLE, JENNY LEIGH, MD
5/15/2013
N8590
VAUGHAN, JEREMY BRANDON, MD
VILLALOBOS, JACKELINNE PILAR,
DO
1/18/2011
N5461
6/15/2011
2/5/2010
N9661
VILLAZANA-KRETZER, DIANA
LETICIA, DO
5/2/2011
N8870
VINEY, REAGAN D'LYNN, MD
2/15/2011
P0317
WALKER, CANDICE ESTELLE, MD
N9145
N7024
WARD, JENAYA JUDONNE, MD
WEBER-LASHORE, AKILAH FAIZAH,
MD
P6936
WHITTY, JANICE ELIZABETH, MD
6/3/2013
P3494
ZACHRISON, JAMIE VERNER, MD
6/1/2012
N9014
P2178
ZAMORA, GUS , MD
ZANDOMENI, GABRIELA MONIKA,
MD
ZIWORITIN, DAMA ALEXANDER,
MD
N8097
FOTE, BARNABAS TALLA, MD
N9989
7/1/2011
3/15/2011
7/1/2010
OBSTETRICS AND
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
6/4/2015 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
2/5/2015 GYNECOLOGY
OBSTETRICS AND
5/2/2016 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
7/1/2016 GYNECOLOGY
OBSTETRICS AND
OBSTETRICS AND
7/1/2015 GYNECOLOGY
OBSTETRICS AND
6/3/2018 GYNECOLOGY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
OBSTETRICS AND
3/1/2016 GYNECOLOGY
OBSTETRICS AND
6/3/2011
6/3/2016 GYNECOLOGY
OBSTETRICS AND
2/10/2012
OCCUPATIONAL
11/15/2010 11/15/2015 MEDICINE
3/1/2011
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Practice City
AMARILLO
HOUSTON
DALLAS
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OTHER SPECIALTY
MATERNAL AND
FETAL MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
TX
TX
SAN ANTONIO TX
Disciplinary
Status Date
4/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/20/2011 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
12/5/2011 None
N/A
ACTIVE
6/6/2013 None
N/A
ACTIVE
LICENSE
ISSUED
1/21/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
5/9/2011 None
N/A
2/15/2011 None
N/A
AUSTIN
TX
ACTIVE
8/10/2011 None
N/A
DALLAS
TX
ACTIVE
3/21/2011 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
7/7/2010 None
N/A
6/3/2013 None
N/A
ACTIVE
6/8/2012 None
N/A
ACTIVE
3/11/2011 None
N/A
KYLE
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 202 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
ROWLETT
TX
ACTIVE
6/16/2011 None
N/A
ELKO
NEW
ORLEANS
NV
ACTIVE
2/20/2012 None
N/A
LA
ACTIVE
2/10/2011 None
N/A
License
Number
Physician Name
N9706
GLENCROSS, PHILIP MARK, MD
P2165
SARDANA, JASMINE SAMUEL, MD
N4895
ALBRITTON, KAREN HALABURT,
MD
P5922
N2913
P6569
N9677
P0178
ALEXANDER, WARREN, MD
ALOBA, MARIA CHONA BRIONES ,
MD
AMARIA, RODABE NAVROZE, MD
BHADKAMKAR, NISHIN ANIL, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
OCCUPATIONAL
PHYSICAL MED. &
5/16/2011
5/16/2016 MEDICINE
REHABILITATION
OCCUPATIONAL
2/10/2012
2/10/2017 MEDICINE
GENERAL PRACTICE
PEDIATRIC
HEMATOLOGY/ONCO
2/5/2010
2/5/2015 ONCOLOGY
LOGY
HEMATOLOGY/ONCO
4/1/2013
4/1/2018 ONCOLOGY
LOGY
HEMATOLOGY 5/29/2009
5/29/2014 ONCOLOGY
INTERNAL MEDICINE
5/15/2013
5/15/2018 ONCOLOGY
5/16/2011
5/16/2016 ONCOLOGY
INTERNAL MEDICINE
HEMATOLOGY 7/1/2011
7/1/2016 ONCOLOGY
INTERNAL MEDICINE
P2211
P1743
CAIRO, MICHELINA MARIE, MD
CHAVEZ MAC GREGOR, MARIANA ,
MD
COURTNEY, KEVIN DALE, MD
P5963
DHAWAN, MANISH, MD
N6268
P4871
P3535
DOWNIE, BENJAMIN JOEL, MD
HAGIN, GERALD DOUGLAS, MD
HE, ZENING, MD
P7132
JAWED, IRFAN, MD
N1695
P6848
P2888
N7450
JESELSOHN, RINATH MALKA, MD
KIM, JAMES, MD
LEE, HUN JU, MD
LIN, WEI , MD
12/12/2008 12/12/2013 ONCOLOGY
6/3/2013
6/3/2018 ONCOLOGY
4/13/2012
4/13/2017 ONCOLOGY
8/16/2010
8/16/2015 ONCOLOGY
P1668
N0968
P1375
MAHALINGAM, DEVALINGAM , MD
MELMED, GAVIN MARK, MD
NIJHAWAN, DEEPAK, MD
12/15/2011 12/15/2016 ONCOLOGY
8/29/2008
8/29/2013 ONCOLOGY
11/4/2011
11/4/2016 ONCOLOGY
N4015
P2161
RADAIDEH, SOFYAN M., MD
ROSS, THEODORA S, MD
8/21/2009
2/10/2012
8/21/2014 ONCOLOGY
2/10/2017 ONCOLOGY
N5396
P2367
SHEKHANI, SHAHID , MD
SIMON, GEORGE RAJAN, MD
2/5/2010
3/1/2012
2/5/2015 ONCOLOGY
3/1/2017 ONCOLOGY
Practice City
LARGO
Registration
Status of
Practice
Texas
State
License
FL
ACTIVE
5/24/2011 None
N/A
ACTIVE
2/13/2012 None
N/A
LICENSE
ISSUED
2/5/2010 None
N/A
TX
ACTIVE
4/4/2013 None
N/A
EL PASO
HOUSTON
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
6/3/2009 None
7/9/2013 None
5/24/2011 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
7/7/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
3/28/2012 None
1/20/2012 None
N/A
N/A
3/1/2017 ONCOLOGY
1/2/2017 ONCOLOGY
DALLAS
4/1/2013
4/1/2018 ONCOLOGY
INTERNAL MEDICINE SHREVEPORT LA
HEMATOLOGY INTERNAL MEDICINE
INTERNAL MEDICINE SIOUX CITY
IA
INTERNAL MEDICINE WAUSAU
WI
7/1/2013
Disciplinary
Status Date
EL PASO
3/1/2012
1/2/2012
6/4/2010
6/4/2015 ONCOLOGY
11/15/2012 11/15/2017 ONCOLOGY
6/8/2012
6/8/2017 ONCOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
4/3/2013 None
N/A
6/4/2010 None
12/21/2012 None
6/13/2012 None
N/A
N/A
N/A
7/1/2013 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
12/29/2008
6/5/2013
4/26/2012
8/26/2010
TX
TX
TX
TX
TX
7/1/2018 ONCOLOGY
INTERNAL MEDICINE
DALLAS
HEMATOLOGY/ONCO
LOGY
SAN ANTONIO
HEMATOLOGY INTERNAL MEDICINE DALLAS
INTERNAL MEDICINE
Page 203 of 301
TX
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
1/12/2012 None
9/5/2008 None
11/9/2011 None
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
10/5/2009 None
2/17/2012 None
N/A
N/A
2/5/2010 None
3/7/2012 None
N/A
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P6296
WEHBE, AHMAD MOUHAMAD, MD
4/12/2013
4/12/2018 ONCOLOGY
P2082
WILLIAM, WILLIAM NASSIB JR, MD
ZURITA SAAVEDRA, AMADO
JAVIER, MD
ABEDI, GELAREH, MD
2/1/2012
2/1/2017 ONCOLOGY
N7768
N7044
9/15/2010
7/15/2010
Registration
Status of
Practice
Texas
State
License
Secondary Specialty
(Self-Designated)
Practice City
HEMATOLOGY INTERNAL MEDICINE SAN ANTONIO TX
ACTIVE
4/17/2013 None
N/A
TX
ACTIVE
2/7/2012 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
9/20/2010 None
7/20/2010 None
N/A
N/A
TX
ACTIVE
8/19/2010 None
N/A
TX
TX
NY
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
8/5/2011
12/3/2009
1/15/2013
8/10/2010
None
None
None
None
N/A
N/A
N/A
N/A
8/1/2011 None
N/A
9/15/2015 ONCOLOGY
7/15/2015 OPHTHALMOLOGY
OPHTHALMOLOGY VITREOUS SURGERY EL PASO
N7384
ADAMS, NEAL A, MD
8/16/2010
P0530
N4236
P5153
N7200
ADYANTHAYA, ROHIT, MD
AGOMO, EMELIKE UCHECHI, MD
AIZMAN, ALEXANDER, MD
AKOR, CHARLOTTE MARTHA, MD
8/1/2011
11/6/2009
1/4/2013
8/2/2010
8/1/2016
11/6/2014
1/4/2018
8/2/2015
P0532
ALI, ABDULFATAH MOHAMED, MD
8/1/2011
OPHTHALMOLOGY VITREOUS SURGERY MCALLEN
GALVESTON
BROOKLYN
HOUSTON
OPHTHALMOLOGY CORNEA
P6321
AMACHER, AARON GEORGE III, MD
5/1/2013
ARLINGTON
K9479
AMATO, MALENA MARIE, MD
12/17/2012 12/17/2017 OPHTHALMOLOGY
K9479
12/17/2012 12/17/2017 OPHTHALMOLOGY
K9479
12/17/2012 12/17/2017 OPHTHALMOLOGY
N8756
ANAND, AASHISH , MD
2/15/2011
P0347
BHATT, ANAND BIPIN, MD
7/15/2011
P0008
P5158
BHULLAR, SHAMINDER SINGH, MD
BLAIR, MICHAEL , MD
6/15/2011
1/4/2013
P2098
BLIEDEN, LAUREN SASHA, MD
2/10/2012
N6191
BROOKS, DAIN B, MD
6/4/2010
OPHTHALMOLOGY
OPHTHALMOLOGY
OPHTHALMOLOGY
OPHTHALMOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
5/7/2013 None
N/A
OPHTHALMOLOGY RECONST SURGERY AUSTIN
TX
ACTIVE
1/1/2013 None
N/A
TX
ACTIVE
1/1/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
1/1/2013 None
N/A
2/15/2011 None
N/A
ACTIVE
7/25/2011 None
N/A
LICENSE
ISSUED
ACTIVE
6/15/2011 None
1/7/2013 None
N/A
N/A
2/17/2012 None
N/A
6/4/2010 None
N/A
PEDIATRIC
OPHTHALMOLOGY
OPHTHALMOLOGY GLAUCOMA
OPHTHALMOLOGY VITREOUS SURGERY
ARLINGTON
Page 204 of 301
TX
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P2961
BROWN, SHANNA JEAN, MD
P5342
BUTLER, MICHELLE RENEE, MD
edicaid
edicaid
End Date
Designated)
5/1/2012
2/1/2013
N0691
P5162
P7623
CHAUDHRY, IMTIAZ MANZOOR, MD
CHAUM, EDWARD, MD
CHONG, JAMES JAY, MD
8/29/2008
1/4/2013
8/15/2013
P3302
N0706
CHU, RICHARD CHUN HSIEN, DO
CONNOR, MICHAEL ADAM, MD
6/1/2012
8/29/2008
P0190
P1985
7/1/2011
2/1/2012
N5007
CRUM, ALISON VOIGT, MD
DANG, TAM II, MD
DE LA TORRE, JAVIER EDUARDO,
MD
2/5/2010
N9448
ECKHART, RODGERS LONG, MD
4/15/2011
N4392
P5627
EKONG, ANTHONY SEBASTIAN, MD
FINNERTY, KATIE NICOLE, MD
11/6/2009
3/1/2013
P5275
FRIEDMAN, DUNCAN AESCTUN,
MD
1/15/2013
N6304
GALVAN, CARLOS ALBERTO, MD
6/4/2010
N6311
GHORAYEB, GHASSAN , MD
6/4/2010
P2993
P6404
GIACOMETTI, JOSEPH, MD
GUTMAN, JUSTIN, MD
5/1/2012
5/1/2013
P2662
HACKL, THEODORE E, MD
4/2/2012
N6344
HARKINS, JAMES PATRICK JR, MD
6/4/2010
N5722
HEBSON, CAROLYN BRAY, MD
4/9/2010
Secondary Specialty
(Self-Designated)
Practice City
LUBBOCK
DALLAS
PEDIATRICS
MEMPHIS
CEDAR HILL
FORT WORTH
AUSTIN
OPHTHALMOLOGY RECONST SURGERY DALLAS
OPHTHALMOLOGY
EL PASO
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
TX
TN
TX
ACTIVE
ACTIVE
ACTIVE
9/24/2008 None
1/10/2013 None
8/16/2013 None
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
6/25/2012 None
9/26/2008 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
8/1/2011 None
2/13/2012 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
4/28/2011 None
N/A
ACTIVE
ACTIVE
1/13/2010 None
3/7/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/17/2013 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
5/7/2012 None
5/21/2013 None
N/A
N/A
4/2/2012 None
N/A
6/4/2010 None
N/A
4/27/2010 None
N/A
OPHTHALMOLOGY ANTERIOR SURGERY
SPRINGFIELD IL
DALLAS
TX
OPHTHALMOLOGY VITREOUS SURGERY BIRMINGHAM
OPHTHALMOLOGY RECONST SURGERY HOUSTON
OPHTHALMOLOGY ANTERIOR SURGERY
Page 205 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
5/3/2012 None
N/A
2/5/2013 None
N/A
AL
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
P5535
HOLLSTEN, JORDAN ENID, MD
N7435
P6649
HUSSEIN, MOHAMED A W, MD
JADAV, DIP SURESHKUMAR, MD
N5743
JANZEN, GRANT PHILLIP, MD
N3760
edicaid
edicaid
End Date
Designated)
2/8/2013
8/16/2010
5/15/2013
4/9/2010
JENNINGS, THOMAS JOSEPH, MD
8/21/2009
N7814
JOHNSON, SHALINI, MD
10/1/2010
P0910
KARTVELISHVILI, ALEX, MD
9/1/2011
N5764
KAVANAUGH, ARTHUR SCOTT, MD
4/9/2010
N9883
P2277
KERR, KEVIN ANDREW, MD
KERR, TREVOR , MD
6/3/2011
3/1/2012
N2145
P6988
KHAN, SHAWN JEHAN, MD
KHANDELWAL, SUMITRA, MD
2/6/2009
6/14/2013
P2474
KHETPAL, VIJAY, MD
3/15/2012
N8804
KIM, SOO YEON, MD
2/15/2011
N5787
P3371
KONTI, JON A, MD
KRAVITZ, DANIEL JAY, MD
4/9/2010
6/1/2012
N8805
KRUGER, MATTHEW MICHAEL, MD
2/15/2011
P3028
LEVAR, JOSHUA , MD
5/1/2012
L7021
LU, MING, MD
11/6/2009
N9737
MAJKA, CHRISTOPHER PAUL, MD
5/16/2011
Secondary Specialty
(Self-Designated)
PLASTIC SURGERY
WITHIN THE HEAD
AND NECK
PEDIATRIC
OPHTHALMOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
SAN ANTONIO TX
ACTIVE
2/27/2013 None
N/A
HOUSTON
SUGAR LAND
ACTIVE
ACTIVE
8/19/2010 None
5/20/2013 None
N/A
N/A
ACTIVE
4/19/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/31/2009 None
N/A
10/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
10/12/2011 None
N/A
4/9/2010 None
N/A
TX
TX
OPHTHALMOLOGY VITREOUS SURGERY BOSTON
MA
PEDIATRIC
BROWNSVILL
OPHTHALMOLOGY
E
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
STEPHENVILL
E
TX
DALLAS
TX
ACTIVE
ACTIVE
6/16/2011 None
3/5/2012 None
N/A
N/A
BRENHAM
HOUSTON
ACTIVE
ACTIVE
2/20/2009 None
6/20/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/26/2012 None
N/A
2/15/2011 None
N/A
4/9/2010 None
6/4/2012 None
N/A
N/A
2/15/2011 None
N/A
5/1/2012 None
N/A
TX
TX
LUFKIN
TX
OPHTHALMOLOGY VITREOUS SURGERY TYLER
CORPUS
CHRISTI
Page 206 of 301
TX
ACTIVE
11/12/2009 None
N/A
TX
ACTIVE
5/24/2011 None
N/A
License
Number
Physician Name
N9740
MARX, DOUGLAS PETE, MD
edicaid
edicaid
End Date
Designated)
5/16/2011
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
P5106
MELTON, JENNIFER LEIGH, MD
12/17/2012 12/17/2017 OPHTHALMOLOGY
GALVESTON
P5106
12/17/2012 12/17/2017 OPHTHALMOLOGY
P5106
N9744
P5422
P7513
MENDIOLA, LAURA LETICIA, MD
MILLER, ADAM RICHARD, MD
MILLIN, JOHN ANDREW, MD
12/17/2012 12/17/2017 OPHTHALMOLOGY
5/16/2011
2/1/2013
8/1/2013
N5884
MORALES, AL P, MD
4/9/2010
N5885
MORALES, MARLENE ELENA, MD
4/9/2010
P6044
P6876
MOSES, ELI, MD
MURPHY, LORI MAE, MD
4/1/2013
6/3/2013
N7848
NADIMPALLI, CHITRA V, MD
10/1/2010
N5906
N8960
P7167
NELLIGAN, RUSSELL WILLIAM, MD
NGO, YEN HOANG, MD
NGUYEN, BAOCHAN, MD
4/9/2010
3/1/2011
7/1/2013
P5864
PALOMBARO, GEREMIE, DO
3/15/2013
N6568
PATEL, SHAMIL SURENDRA, MD
6/4/2010
OPHTHALMOLOGY RECONST SURGERY EL PASO
G3685
PESICKA, GARY ALLEN, MD
4/12/2013
OPHTHALMOLOGY VITREOUS SURGERY DALLAS
P5707
PHILLIPS, MARGARET ELIZABETH,
MD
3/1/2013
N6964
N2742
PINNINTI, USHA, MD
QURESHI, YOUSUF AMIN, MD
7/1/2010
4/3/2009
GALVESTON
GALVESTON
LAS CRUCES
OPHTHALMOLOGY RECONST SURGERY DALLAS
DALLAS
OPHTHALMOLOGY
SAN ANTONIO
PORT
ARTHUR
DALLAS
DALLAS, TX
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
TX
ISSUED
LICENSE
TX
ISSUED
LICENSE
TX
ISSUED
ACTIVE
ACTIVE
NM
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
5/19/2011 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012
5/20/2011
2/5/2013
8/7/2013
None
None
None
None
N/A
N/A
N/A
N/A
4/9/2010 None
N/A
TX
ACTIVE
4/21/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
4/8/2013 None
6/7/2013 None
N/A
N/A
TX
ACTIVE
10/15/2010 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/20/2010 None
3/4/2011 None
7/5/2013 None
N/A
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
3/19/2013 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
4/18/2013 None
N/A
TX
ACTIVE
3/18/2013 None
N/A
OPHTHALMOLOGY VITREOUS SURGERY HOUSTON
KATY
TX
TX
ACTIVE
ACTIVE
7/5/2010 None
4/16/2009 None
N/A
N/A
Page 207 of 301
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P1686
REEVES, DONNY LUPRICE, MD
12/15/2011 12/15/2016 OPHTHALMOLOGY
P7023
RICHANI, KARINA, MD
6/14/2013
P6257
RISNER, DAVID SCHULLER JR, MD
4/12/2013
P7027
ROBINSON, SHAUN B, MD
6/14/2013
N6637
SANCHEZ, CECILIA RAQUEL, MD
6/4/2010
P3442
SCHMID, KRISTIN LEA, MD
6/1/2012
N6023
SHULKIN, ZEV ANDREW, MD
4/9/2010
P1410
SNIEGOWSKI, MATTHEW
CONRAD, MD
11/4/2011
J5485
N9136
SOFINSKI, SANDRA JEAN, MD
SONI, RUHI SINGH, MD
3/1/2012
3/15/2011
N9305
SPENGLER, ADAM LAUBACH, MD
4/1/2011
N8462
STANCIU, NATALIE, MD
1/3/2011
N4128
N8352
STERN, AUGUSTUS GRAHAM, MD
STEWART, ADAM KEITH, MD
N4770
P5486
P5307
SUHR, ABRAHAM WONDUK, MD
TIRGAN, NIMA, MD
TREVINO, MARK JOSEPH, MD
VERNER-COLE, ELIZABETH ANNE,
MD
N7373
P2805
VEST, ZACHARY , MD
8/21/2009
12/15/2010 12/15/2015 OPHTHALMOLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
OPHTHALMOLOGY - CORPUS
RECONST SURGERY CHRISTI
TX
ACTIVE
12/26/2011 None
N/A
TX
ACTIVE
7/10/2013 None
N/A
TX
ACTIVE
4/22/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
6/24/2013 None
N/A
6/4/2010 None
N/A
OPHTHALMOLOGY ANTERIOR SURGERY TYLER
HOUSTON
PEDIATRIC
OPHTHALMOLOGY
HOUSTON
TX
ACTIVE
6/4/2012 None
N/A
DALLAS
TX
ACTIVE
4/26/2010 None
N/A
TX
ACTIVE
11/15/2011 None
N/A
OPHTHALMOLOGY ANTERIOR SURGERY MONTCLAIR
HOUSTON
CA
TX
ACTIVE
ACTIVE
3/7/2012 None
3/28/2011 None
N/A
N/A
TX
ACTIVE
4/6/2011 None
N/A
LICENSE
ISSUED
1/3/2011 None
N/A
HOUSTON
OPHTHALMOLOGY RECONST SURGERY
CORNEA
REFRACTIVE
SURGERY
HUMBLE
TEMPLE
SAN ANTONIO
11/6/2009
2/1/2013
1/15/2013
8/2/2010
4/2/2012
OPHTHALMOLOGY 4/2/2017 OPHTHALMOLOGY
GLAUCOMA
Page 208 of 301
DALLAS
TX
TX
ACTIVE
ACTIVE
9/2/2009 None
12/21/2010 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
11/11/2009 None
2/6/2013 None
2/13/2013 None
N/A
N/A
N/A
ACTIVE
8/16/2010 None
N/A
ACTIVE
4/25/2012 None
N/A
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P1505
WIGGINS, JOSHUA THOMAS, MD
P0519
WIRASZKA, TOMASZ ADAM, MD
7/15/2011
N9336
P2176
WYKOFF, CHARLES CLIFTON, MD
YIN, VIVIAN TSUI-WEN, MD
4/1/2011
2/10/2012
N8038
MCINTIRE, LISA UHL, MD
10/29/2010
P4985
MONTES, JORGE ANTONIO, MD
11/30/2012
N1250
ALSHEIKH, ODAY, MD
10/10/2008
P4759
11/1/2012
P0832
GEORGE, MICHAEL ROBERT, MD
HAWTHORNE, KRISTEN MICHELLE,
MD
P2672
HESTER, CHRISTIAN CARDELL, MD
4/2/2012
P3208
MOSS, HART BEAMAN, MD
N6331
GROVER, DAVINDER SINGH, MD
6/4/2010
P7362
7/15/2013
N3735
THUNG, ELAINE GIOKLAN, MD
DEBACKER, CHRISTOPHER
MACDONALD, MD
HOLCK, DAVID EDWARD EINAR,
MD
P1111
MOTAMARRY, SILUS, MD
10/3/2011
N3432
ALEJANDRO, KARLA C, MD
8/21/2009
P5039
BROWN, C CHRISTOPHER, MD
12/17/2012
P5039
12/17/2012
P5039
12/17/2012
N5646
Secondary Specialty
(Self-Designated)
Practice City
11/15/2011 11/15/2016 OPHTHALMOLOGY
8/26/2011
5/15/2012
4/9/2010
8/21/2009
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
OPHTHALMOLOGY RECONST SURGERY
OPHTHALMOLOGY 4/1/2016 OPHTHALMOLOGY
VITREOUS SURGERY
ONCOLOGY
OPHTHALMOLOGY OPHTHALMOLOGY 10/29/2015 ANTERIOR SURGERY CORNEA
OPHTHALMOLOGY 11/30/2017 ANTERIOR SURGERY OPHTHALMOLOGY
OPHTHALMOLOGY 10/10/2013 CORNEA
GENERAL PRACTICE
OPHTHALMOLOGY
OPHTHALMOLOGY
OPHTHALMOLOGY 6/4/2015 GLAUCOMA
OPHTHALMOLOGY 7/15/2018 GLAUCOMA
OPHTHALMOLOGY
OPHTHALMOLOGY 4/9/2015 RECONST SURGERY COSMETIC SURGERY
OPHTHALMOLOGY 8/21/2014 RECONST SURGERY OPHTHALMOLOGY
OPHTHALMOLOGY 10/3/2016 RECONST SURGERY UNSPECIFIED
OPHTHALMOLOGY 8/21/2014 VITREOUS SURGERY OPHTHALMOLOGY
OPHTHALMOLOGY 12/17/2017 VITREOUS SURGERY
Page 209 of 301
LICENSE
ISSUED
HOUSTON
HOUSTON
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/15/2011 None
N/A
7/15/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/6/2011 None
2/27/2012 None
N/A
N/A
10/29/2010 None
N/A
SAN ANTONIO TX
ACTIVE
12/17/2012 None
N/A
GALVESTON
TX
ACTIVE
11/5/2008 None
N/A
IRVING
TX
ACTIVE
LICENSE
ISSUED
11/8/2012 None
N/A
8/26/2011 None
N/A
HOUSTON
TX
ACTIVE
4/11/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
5/21/2012 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
7/19/2013 None
N/A
SAN ANTONIO TX
ACTIVE
4/26/2010 None
N/A
SAN ANTONIO TX
ACTIVE
8/31/2009 None
N/A
SAN ANTONIO TX
CORPUS
CHRISTI
TX
ACTIVE
10/5/2011 None
N/A
ACTIVE
8/31/2009 None
N/A
SAN ANTONIO TX
ACTIVE
12/20/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/20/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/20/2012 None
N/A
HOUSTON
License
Number
Physician Name
P2613
CHEN, CAROLYN , MD
P7258
CHIRANAND, PAULPOJ, MD
P0362
COFFEE, ROBERT EARL III, MD
P2435
EL ANNAN, JAAFAR FADL, MD
N5682
FURLAN, JULIE ENRIGHT, MD
N5719
HAYES, BARTLETT HARDING II, MD
JARDELEZA, MARIA STEPHANIE
RAVADILLA, MD
N7287
N2637
N9470
MAJOR, JAMES CALDER JR, MD
MELETH, ANNAL DHANANJAYAN,
MD
P2500
MOSCOSO, WALTER ENRIQUE, MD
N2684
N5933
NEWMAN, JOSEPH MATTHEW, MD
PARSCHAUER, JUSTIN KENNETH,
DO
P6890
PIWONKA, KYLE THOMAS, DO
P1583
RAHMAN, HASSAN TOUFIQUR, MD
edicaid
edicaid
End Date
Designated)
OPHTHALMOLOGY 4/2/2012
4/2/2017 VITREOUS SURGERY
P2782
SCHEFLER, AMY CLAIRE, MD
4/2/2012
4/2/2017
P0496
SHEPARD, DANIEL PAUL, MD
7/15/2011
7/15/2016
N8855
SOANS, FRANCIS PETER, MD
N2888
WONG, ROBERT WILLIAM , MD
N8600
ZHUK, STANISLAV A, MD
2/15/2011
2/15/2016
4/3/2009
4/3/2014
1/18/2011
1/18/2016
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
OPHTHALMOLOGY
OPHTHALMOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
4/9/2012 None
N/A
7/15/2013 None
N/A
HOUSTON
TX
ACTIVE
8/15/2011 None
N/A
HOUSTON
TX
ACTIVE
3/19/2012 None
N/A
ACTIVE
4/20/2010 None
N/A
TX
ACTIVE
4/20/2010 None
N/A
SAN ANTONIO TX
ACTIVE
8/24/2010 None
N/A
HOUSTON
TX
ACTIVE
4/14/2009 None
N/A
HOUSTON
CORPUS
CHRISTI
TX
ACTIVE
4/22/2011 None
N/A
TX
ACTIVE
3/19/2012 None
N/A
TX
ACTIVE
4/8/2009 None
N/A
OPHTHALMOLOGY
DALLAS
CORPUS
CHRISTI
TX
ACTIVE
5/3/2010 None
N/A
OPHTHALMOLOGY
MCALLEN
TX
ACTIVE
6/17/2013 None
N/A
OPHTHALMOLOGY
HOUSTON
TX
ACTIVE
12/7/2011 None
N/A
OPHTHALMOLOGY VITREOUS SURGERY HOUSTON
TX
ACTIVE
4/3/2012 None
N/A
ACTIVE
LICENSE
ISSUED
8/2/2011 None
N/A
2/15/2011 None
N/A
OPHTHALMOLOGY
HOUSTON
OPHTHALMOLOGY
OPHTHALMOLOGY
SANTA MARIA CA
OPHTHALMOLOGY
OPHTHALMOLOGY
Page 210 of 301
AUSTIN
NEW
ORLEANS
TX
ACTIVE
4/9/2009 None
N/A
LA
ACTIVE
2/14/2011 None
N/A
License
Number
Physician Name
N6203
BUSCH, ROBERT JOHN, MD
P6609
DURAINI, MAZEN , MD
P4650
GARRETT, JAMES BRYAN, MD
N5146
KAO, HERMAN , MD
N3815
LARGENT, MATTHEW
CHRISTOPHER, MD
P6467
MICHAEL, WAYNE ALAN, MD
P6046
NAIDU, KARTHIK, MD
P7692
PUGAO, REO, MD
P7351
SHUM, JONATHAN, MD
N4160
THOTA, GOPIKIRAN , MD
N9000
TIWANA, G PAUL SINGH, MD
N8741
VUU, THAI MINH, MD
N7032
WILLIAMS, FAYETTE CREED, MD
ABDELGAWAD, AMR MOHAMMED
ATEF, MD
N6801
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
ORAL &
MAXILLOFACIAL
6/4/2010
6/4/2015 SURGERY
ORAL &
MAXILLOFACIAL
5/15/2013
5/15/2018 SURGERY
ORAL &
MAXILLOFACIAL
10/15/2012 10/15/2017 SURGERY
ORAL &
MAXILLOFACIAL
2/5/2010
2/5/2015 SURGERY
ORAL &
MAXILLOFACIAL
8/21/2009
8/21/2014 SURGERY
ORAL &
MAXILLOFACIAL
5/1/2013
5/1/2018 SURGERY
ORAL &
MAXILLOFACIAL
4/1/2013
4/1/2018 SURGERY
ORAL &
ORAL &
MAXILLOFACIAL
MAXILLOFACIAL
8/15/2013
8/15/2018 SURGERY
SURGERY
ORAL &
MAXILLOFACIAL
HEAD AND NECK
7/15/2013
7/15/2018 SURGERY
SURGERY
ORAL &
MAXILLOFACIAL
8/21/2009
8/21/2014 SURGERY
ORAL &
MAXILLOFACIAL
3/1/2011
3/1/2016 SURGERY
ORAL &
MAXILLOFACIAL
2/4/2011
2/4/2016 SURGERY
ORAL &
MAXILLOFACIAL
7/1/2010
7/1/2015 SURGERY
ORTHOPEDIC
PEDIATRIC
7/1/2010
7/1/2015 SURGERY
ORTHOPEDICS
Page 211 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/4/2010 None
N/A
IRVING
TX
ACTIVE
5/31/2013 None
N/A
COLLEGE
STATION
TX
ACTIVE
10/19/2012 None
N/A
2/5/2010 None
N/A
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
10/5/2009 None
N/A
DALLAS
ACTIVE
5/8/2013 None
N/A
LICENSE
ISSUED
4/1/2013 None
N/A
TX
EL PASO
TX
ACTIVE
8/21/2013 None
N/A
HOUSTON
TX
ACTIVE
8/6/2013 None
N/A
CEDAR PARK
TX
ACTIVE
8/26/2009 None
N/A
DALLAS
TX
ACTIVE
4/25/2011 None
N/A
HOUSTON
TX
ACTIVE
2/10/2011 None
N/A
7/1/2010 None
N/A
7/21/2010 None
N/A
LICENSE
ISSUED
EL PASO
TX
ACTIVE
License
Number
P6311
Physician Name
AKHTAR, OMAR H, MD
edicaid
edicaid
End Date
Designated)
ORTHOPEDIC
5/1/2013
5/1/2018 SURGERY
P2574
AMOR, COURTNEY JOSEPH, MD
4/2/2012
N9802
ANZ, ALAN, MD
6/3/2011
N4927
BACH, HAROLD GREGORY, MD
N4281
ORTHOPEDIC
4/2/2017 SURGERY
ORTHOPEDIC
6/3/2016 SURGERY
2/5/2010
2/5/2015
BANKS, KRISTINE ELIZABETH, MD
11/6/2009
11/6/2014
P2096
BEICKER, CLINT ROYAL, MD
2/10/2012
2/10/2017
P5933
BELTRAN, MICHAEL JOHN, MD
4/1/2013
4/1/2018
P2206
BENTON, EDWARD GARRISON JR,
MD
CAMARILLO, RANDAL MATTHEW,
MD
N8177
COTE, ADAM ZEIHER, DO
P7392
8/1/2013
3/1/2012
12/1/2010
P0189
COYNER, KATHERINE JUNE, MD
7/1/2011
N5000
CURRIE, OSCAR JOVAN, MD
2/5/2010
N7246
DARWISH, ASHRAF HAMZEH, MD
8/2/2010
P7423
8/1/2013
N5009
DEAN, THAD JAMES, DO
DEFRANCIS, JASON GREGORY,
MD
P0823
DICE, DAVID LOUIS JR, MD
2/5/2010
8/26/2011
P1746
DICKSON, DOUGLAS DARKO, MD
1/2/2012
N9696
DOMINGUEZ, DAVID EMILIO, MD
5/16/2011
ORTHOPEDIC
SURGERY
ORTHOPEDIC
SURGERY
ORTHOPEDIC
SURGERY
ORTHOPEDIC
SURGERY
ORTHOPEDIC
8/1/2018 SURGERY
ORTHOPEDIC
3/1/2017 SURGERY
ORTHOPEDIC
12/1/2015 SURGERY
ORTHOPEDIC
7/1/2016 SURGERY
ORTHOPEDIC
2/5/2015 SURGERY
ORTHOPEDIC
8/2/2015 SURGERY
ORTHOPEDIC
8/1/2018 SURGERY
ORTHOPEDIC
2/5/2015 SURGERY
ORTHOPEDIC
8/26/2016 SURGERY
ORTHOPEDIC
1/2/2017 SURGERY
ORTHOPEDIC
5/16/2016 SURGERY
Secondary Specialty
(Self-Designated)
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
AUSTIN
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ORTHOPEDIC
SURGERY OF THE
SPINE
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
SPORTS MEDICINE ORTHOPEDICS
ORTHOPEDIC
SURGERY OF THE
SPINE
ARTHRITIS & JOINT
IMPLANT SURGERY
ORTHOPEDIC
SURGERY OF THE
SPINE
LICENSE
ISSUED
Disciplinary
Status Date
5/7/2013 None
N/A
4/13/2012 None
N/A
6/3/2011 None
N/A
2/5/2010 None
N/A
HOUSTON
TX
ACTIVE
12/31/2009 None
N/A
LUBBOCK
FORT SAM
HOUSTON
TX
ACTIVE
2/20/2012 None
N/A
TX
ACTIVE
4/29/2013 None
N/A
WACO
TX
ACTIVE
8/6/2013 None
N/A
ACTIVE
4/2/2012 None
N/A
ACTIVE
12/15/2010 None
N/A
7/7/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
9/13/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/10/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
9/2/2011 None
N/A
LICENSE
ISSUED
1/2/2012 None
N/A
5/31/2011 None
N/A
DALLAS
PLANO
TX
TX
FORT WORTH TX
ACTIVE
LICENSE
ISSUED
ACTIVE
Page 212 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
ORTHOPEDIC
N5661
DUMAIS, JULES ARTHUR, MD
4/9/2010
4/9/2015 SURGERY
TRAUMA
ORTHOPEDIC
N5662
DWYER, MATTHEW MICHAEL, MD
4/9/2010
4/9/2015 SURGERY
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
N9046
EDWARDS, KENNY, MD
3/15/2011
3/15/2016 SURGERY
SPINE
ESPINOZA-ERVIN, CHRISTOPHER,
ORTHOPEDIC
P2983
MD
5/1/2012
5/1/2017 SURGERY
ORTHOPEDIC
P2237
FARR, MICHAEL BENJAMIN, DO
3/1/2012
3/1/2017 SURGERY
ORTHOPEDIC
SPORTS MEDICINE P7271
FERGUSON, MATTHEW PAUL, MD
7/15/2013
7/15/2018 SURGERY
ORTHOPEDICS
FITZPATRICK, THOMAS MICHAEL,
ORTHOPEDIC
P2987
MD
5/1/2012
5/1/2017 SURGERY
ORTHOPEDIC
SPORTS MEDICINE N8396
FLOYD, IRA LENORRIS, MD
1/3/2011
1/3/2016 SURGERY
ORTHOPEDICS
ORTHOPEDIC
P0826
FREEDHAND, ADAM M, MD
8/26/2011
8/26/2016 SURGERY
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
P1302
FRIEDLAND, JOHN T, MD
11/4/2011
11/4/2016 SURGERY
SPINE
ORTHOPEDIC
N3035
FRINK, SPENCER JAMES SR, MD
5/29/2009
5/29/2014 SURGERY
ORTHOPEDIC
TRAUMATIC
P6391
GAINES, ROBERT J, MD
5/1/2013
5/1/2018 SURGERY
SURGERY
ORTHOPEDIC
ADULT
P1757
GALLAGHER, SEAN MICHAEL, MD
1/2/2012
1/2/2017 SURGERY
RECONSTRUCTION
ORTHOPEDIC
P3332
GILLIAM, BRADLEY DALE, MD
6/1/2012
6/1/2017 SURGERY
ADULT
ORTHOPEDIC
RECONSTRUCTIVE
P0979
GONZALEZ, CARLOS, MD
9/15/2011
9/15/2016 SURGERY
ORTHOPEDICS
ORTHOPEDIC
GORADIA, VIPOOL KIRIT, MD
8/15/2013
8/15/2018 SURGERY
ORTHOPEDICS
ORTHOPEDIC
N3694
GRAVES, RICHARD MARSHALL, MD
8/21/2009
8/21/2014 SURGERY
ORTHOPEDIC
P0597
HAKIM, VICTOR NABEEL, MD
8/1/2011
8/1/2016 SURGERY
ORTHOPEDIC
N7621
HANSEN, THOMAS ERIC, MD
9/1/2010
9/1/2015 SURGERY
Page 213 of 301
Practice City
LUBBOCK
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
4/26/2010 None
N/A
SAN ANTONIO TX
ACTIVE
4/21/2010 None
N/A
PLANO
ACTIVE
LICENSE
ISSUED
3/18/2011 None
N/A
5/1/2012 None
N/A
ACTIVE
3/13/2012 None
N/A
LUBBOCK
TX
JACKSONVILL
E
TX
ACTIVE
8/23/2013 None
N/A
ACTIVE
6/5/2012 None
N/A
DEL RIO
ACTIVE
LICENSE
ISSUED
1/7/2011 None
N/A
8/26/2011 None
N/A
TX
TX
SAN ANTONIO TX
ACTIVE
11/16/2011 None
N/A
SAN ANTONIO TX
ACTIVE
6/15/2009 None
N/A
LUBBOCK
TX
ACTIVE
5/3/2013 None
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
1/4/2012 None
N/A
6/1/2012 None
N/A
EL PASO
TX
ACTIVE
9/21/2011 None
N/A
HUMBLE
TX
ACTIVE
9/2/2013 None
N/A
FT. HOOD
TX
ACTIVE
8/28/2009 None
N/A
PLANO
TX
ACTIVE
8/31/2011 None
N/A
ACTIVE
10/6/2010 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N3071
HARDY, BRIAN THOMAS , MD
N6346
HARTSHORN, CODY JACKSON, MD
6/4/2010
P0903
9/1/2011
P0833
HASLAM, SEAN GREGORY, MD
HENDERSON, CHRISTOPHER EAN,
MD
8/26/2011
N0837
HOLLAND, COURTNEY ALLEN, MD
8/29/2008
P5994
P6642
HORTON, JOSEPH, MD
HOTCHKISS, WILLIAM RICHARD,
MD
N1350
HUSSAINI, AKBAR ALY, MD
N9880
P7289
IVY, AMANDA MICHELLE, MD
JAGLOWSKI, JEFFREY ROBERT,
MD
N7929
JOHNSON, MICHAEL EDWARD, MD
P5390
JOHNSON, STEVEN MICHAEL, DO
N7707
KANZ, BRIAN NOLAN, MD
P4660
KENNEDY, CHAD MATTHEW, MD
P4472
KINSLER, ALISON , MD
N6903
KNIGHT, CAMERON DEWAYNE, MD
N5785
P7659
KODALI, PRADEEP, MD
KUMMERFELD, DAVID ANDREW,
MD
N9585
LALLISS, STEVEN JOHN, MD
N8027
LEBA, THU BA, MD
5/29/2009
4/1/2013
5/15/2013
10/10/2008
6/3/2011
7/15/2013
10/15/2010
2/1/2013
9/15/2010
10/15/2012
9/17/2012
7/1/2010
4/9/2010
8/15/2013
5/2/2011
10/29/2010
ORTHOPEDIC
5/29/2014 SURGERY
ORTHOPEDIC
6/4/2015 SURGERY
ORTHOPEDIC
9/1/2016 SURGERY
ORTHOPEDIC
8/26/2016 SURGERY
ORTHOPEDIC
8/29/2013 SURGERY
ORTHOPEDIC
4/1/2018 SURGERY
ORTHOPEDIC
5/15/2018 SURGERY
ORTHOPEDIC
10/10/2013 SURGERY
ORTHOPEDIC
6/3/2016 SURGERY
ORTHOPEDIC
7/15/2018 SURGERY
ORTHOPEDIC
10/15/2015 SURGERY
ORTHOPEDIC
2/1/2018 SURGERY
ORTHOPEDIC
9/15/2015 SURGERY
ORTHOPEDIC
10/15/2017 SURGERY
ORTHOPEDIC
9/17/2017 SURGERY
ORTHOPEDIC
7/1/2015 SURGERY
ORTHOPEDIC
4/9/2015 SURGERY
ORTHOPEDIC
8/15/2018 SURGERY
ORTHOPEDIC
5/2/2016 SURGERY
ORTHOPEDIC
10/29/2015 SURGERY
Secondary Specialty
(Self-Designated)
SURGERY
Practice City
AUSTIN
PLANO
ORTHOPEDIC
TRAUMA
ORTHOPEDIC
TRAUMA
SPORTS MEDICINE
(ORTH SURG)
Registration
Status of
Practice
Texas
State
License
TX
TX
Page 214 of 301
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
6/10/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/13/2011 None
N/A
8/26/2011 None
N/A
EL PASO
ALAMOGORD
O
TX
ACTIVE
9/15/2008 None
N/A
NM
ACTIVE
4/3/2013 None
N/A
DALLAS
TX
ACTIVE
5/17/2013 None
N/A
AUSTIN
TX
ACTIVE
10/24/2008 None
N/A
SAN MARCOS TX
ACTIVE
6/13/2011 None
N/A
HOUSTON
ACTIVE
7/22/2013 None
N/A
ACTIVE
11/5/2010 None
N/A
ACTIVE
2/21/2013 None
N/A
ACTIVE
9/21/2010 None
N/A
SAN ANTONIO TX
ACTIVE
11/13/2012 None
N/A
EL PASO
ACTIVE
9/21/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
7/12/2010 None
N/A
4/9/2010 None
N/A
8/15/2013 None
N/A
5/2/2011 None
N/A
10/29/2010 None
N/A
TX
ORTHOPEDICS
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P2719
LIBERMAN, SHARI RACHEL, MD
4/2/2012
N5808
LIEBERMAN, ISADOR HARRY, MD
4/9/2010
N9730
LIN, DAVID LONG I, MD
P5102
LIU, HONGBO, MD
12/17/2012
P5102
LIU, HONGBO, MD
12/17/2012
P5102
LIU, HONGBO, MD
12/17/2012
N8119
LOW, BRANDON O'HARA, MD
11/15/2010
5/16/2011
P7152
LUE, JEFFREY , MD
7/1/2013
N5220
MANUEL, JACOB BENJAMIN, MD
2/5/2010
P0437
MARSH, DAVID GEORGE JR, MD
7/15/2011
L5833
MCGRORY, JAMES EDWARD, MD
10/1/2010
P7311
MEARS, SIMON CAVENDISH, MD
7/15/2013
N8692
MOEN, TODD CHRISTOPHER, MD
2/4/2011
N8430
NATIVIDAD, TORIBIO TOMAS, MD
1/3/2011
N9274
NEELY, GREGORY MARK, MD
4/1/2011
P0264
NEFF, ROBERT SWANSON II, MD
7/1/2011
N9106
OTT, SUSAN MARIE, DO
P6883
PALISCH, CATHERINE , MD
N7156
PARRELLA, MARK STEPHEN, MD
3/15/2011
6/3/2013
7/15/2010
ORTHOPEDIC
4/2/2017 SURGERY
ORTHOPEDIC
4/9/2015 SURGERY
ORTHOPEDIC
5/16/2016 SURGERY
ORTHOPEDIC
12/17/2017 SURGERY
ORTHOPEDIC
12/17/2017 SURGERY
ORTHOPEDIC
12/17/2017 SURGERY
ORTHOPEDIC
11/15/2015 SURGERY
ORTHOPEDIC
7/1/2018 SURGERY
ORTHOPEDIC
2/5/2015 SURGERY
ORTHOPEDIC
7/15/2016 SURGERY
ORTHOPEDIC
10/1/2015 SURGERY
ORTHOPEDIC
7/15/2018 SURGERY
ORTHOPEDIC
2/4/2016 SURGERY
ORTHOPEDIC
1/3/2016 SURGERY
ORTHOPEDIC
4/1/2016 SURGERY
ORTHOPEDIC
7/1/2016 SURGERY
ORTHOPEDIC
3/15/2016 SURGERY
ORTHOPEDIC
6/3/2018 SURGERY
ORTHOPEDIC
7/15/2015 SURGERY
Secondary Specialty
(Self-Designated)
SURGERY
ORTHOPEDIC
SURGERY OF THE
SPINE
ORTHOPEDIC
SURGERY OF THE
SPINE
Practice City
Registration
Status of
Practice
Texas
State
License
Page 215 of 301
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
4/9/2012 None
N/A
PLANO
TX
LICENSE
ISSUED
4/9/2010 None
N/A
HOUSTON
TX
ACTIVE
5/24/2011 None
N/A
FULTON
KY
ACTIVE
12/27/2012 None
N/A
FULTON
KY
ACTIVE
12/27/2012 None
N/A
FULTON
KY
ACTIVE
12/27/2012 None
N/A
GALVESTON
TX
ACTIVE
11/22/2010 None
N/A
PLANO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/29/2013 None
N/A
2/5/2010 None
N/A
7/15/2011 None
N/A
ACTIVE
10/11/2010 None
N/A
ACTIVE
8/13/2013 None
N/A
ACTIVE
2/14/2011 None
N/A
ACTIVE
1/7/2011 None
N/A
PLANO
TX
OTHER SPECIALTY
ORTHOPEDIC
TRAUMA
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
ACTIVE
4/19/2011 None
N/A
HOUSTON
TX
ACTIVE
7/6/2011 None
N/A
HARLINGEN
TX
ACTIVE
3/23/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
6/6/2013 None
N/A
7/15/2010 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N2754
RHIM, RICHARD DONGIL , MD
4/3/2009
N5970
RHODES, RICHARD D, MD
4/9/2010
P0785
RICHARDSON, KEVIN DEWAYNE,
DO
P2059
RODRIGO, JUAN JOSE, MD
2/1/2012
N6638
SANDU, CEZAR DANIEL, MD
6/4/2010
P0872
SANTORA, STEPHEN D, MD
8/26/2011
2/5/2010
ORTHOPEDIC
8/15/2016 SURGERY
ORTHOPEDIC
2/1/2017 SURGERY
ORTHOPEDIC
6/4/2015 SURGERY
ORTHOPEDIC
8/26/2016 SURGERY
ORTHOPEDIC
4/9/2015 SURGERY
ORTHOPEDIC
12/12/2013 SURGERY
ORTHOPEDIC
4/2/2017 SURGERY
ORTHOPEDIC
10/17/2016 SURGERY
ORTHOPEDIC
7/1/2016 SURGERY
ORTHOPEDIC
4/9/2015 SURGERY
ORTHOPEDIC
1/15/2018 SURGERY
ORTHOPEDIC
4/1/2016 SURGERY
ORTHOPEDIC
7/15/2015 SURGERY
ORTHOPEDIC
3/1/2018 SURGERY
ORTHOPEDIC
6/4/2015 SURGERY
ORTHOPEDIC
2/5/2015 SURGERY
7/15/2010
ORTHOPEDIC
7/15/2015 SURGERY
8/15/2011
N6008
SELLARDS, ROBERT ALLEN, MD
4/9/2010
N1887
SEROYER, SHANE THOMAS, MD
12/12/2008
P2786
SHANI, RAJ HARRY, MD
P1227
SIMON, PATRICK MICHAEL, MD
P0296
SINGH, KRISHNA ANJALI, MD
7/1/2011
N6036
SOUDER, NICHOLAS PAUL, MD
SPAGNUOLO, MICHAEL WILLIAM,
DO
4/9/2010
P5305
4/2/2012
10/17/2011
1/15/2013
N9306
STAHL, DANIEL LEE, MD
N7179
STRAHAN, ARTHUR LANE JR, MD
P5739
STRYKER, LOUIS SAMUEL, MD
3/1/2013
N6702
SWANSON, TODD VICTOR, MD
6/4/2010
N5426
TAGGART, GREGORY ALAN, MD
N7183
THOMAS, RYAN BLAINE, MD
ORTHOPEDIC
4/3/2014 SURGERY
ORTHOPEDIC
4/9/2015 SURGERY
4/1/2011
7/15/2010
Secondary Specialty
(Self-Designated)
ORTHOPEDIC
SURGERY OF THE
SPINE
Practice City
EULESS
ORTHOPEDIC
SURGERY OF THE
SPINE
ARTHRITIS & JOINT
IMPLANT SURGERY
SPORTS MEDICINE
(ORTH SURG)
WACO
ARLINGTON
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
SAN ANTONIO TX
TEMPLE
TX
ORTHOPEDIC
TRAUMA
FOOT AND ANKLE,
ORTHOPEDICS
SURGERY
Page 216 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
4/15/2009 None
N/A
ACTIVE
4/27/2010 None
N/A
LICENSE
ISSUED
8/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
2/29/2012 None
N/A
6/4/2010 None
N/A
8/26/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
3/10/2009 None
N/A
4/2/2012 None
N/A
ACTIVE
10/24/2011 None
N/A
ACTIVE
7/11/2011 None
N/A
ACTIVE
4/27/2010 None
N/A
ACTIVE
LICENSE
ISSUED
1/17/2013 None
N/A
4/1/2011 None
N/A
MARSHALL
TX
ACTIVE
7/20/2010 None
N/A
CHARLOTTE
NC
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/11/2013 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
7/23/2010 None
N/A
SAN ANTONIO TX
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
ORTHOPEDIC
P0507
TINUBU, BABA JIDE MOHAMED, MD
7/15/2011
7/15/2016 SURGERY
TRAUMA
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
N8252
TRUUMEES, EERIC, MD
12/1/2010
12/1/2015 SURGERY
SPINE
WALKER, TORRANCE ANTHONY,
ORTHOPEDIC
MD
1/17/2012
1/17/2017 SURGERY
ORTHOPEDICS
ORTHOPEDIC
N4831
WALLACE, HENRY CASTON II, MD
11/6/2009
11/6/2014 SURGERY
ORTHOPEDIC
WALTERS, JASON ANTHONY, MD
8/15/2013
8/15/2018 SURGERY
ORTHOPEDICS
ORTHOPEDIC
P1711
WELLER, AMANDA LINDSLEY, MD
12/15/2011 12/15/2016 SURGERY
K4295
WILKINSON, EVERETT JAMES JR,
DO
5/16/2011
P5905
WILKOFSKY, IAN GEOFF, MD
3/15/2013
P7228
WINTER, LANCE RICHARD, DO
P1251
WOICZIK, MARCELLA RAE, MD
P1437
WRIGHT, COY ALLEN, MD
N6121
ZHAO, JEFF XINDA, DO
7/1/2013
10/17/2011
11/4/2011
4/9/2010
P0812
ZISSIMOS, ANTHONY GEORGE, MD
8/15/2011
P2409
ADU-LARTEY, SAMUEL MAXWELL,
DO
3/15/2012
N8167
BELANGER, THEODORE ANDREW,
MD
12/1/2010
N5846
MASSANET VOLLRATH, JOSE M.,
MD
4/9/2010
N5289
O'BRIEN, MICHAEL FRANCIS, MD
2/5/2010
ORTHOPEDIC
5/16/2016 SURGERY
ORTHOPEDIC
3/15/2018 SURGERY
ORTHOPEDIC
7/1/2018 SURGERY
ORTHOPEDIC
10/17/2016 SURGERY
ORTHOPEDIC
11/4/2016 SURGERY
ORTHOPEDIC
4/9/2015 SURGERY
ORTHOPEDIC
8/15/2016 SURGERY
ORTHOPEDIC
SURGERY OF THE
3/15/2017 SPINE
ORTHOPEDIC
SURGERY OF THE
12/1/2015 SPINE
ORTHOPEDIC
SURGERY OF THE
4/9/2015 SPINE
ORTHOPEDIC
SURGERY OF THE
2/5/2015 SPINE
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
7/20/2011 None
N/A
AUSTIN
TX
ACTIVE
2/9/2011 None
N/A
PINE BLUFF
AR
ACTIVE
2/2/2012 None
N/A
TEMPLE
TX
ACTIVE
12/7/2009 None
N/A
MCKINNEY
TX
ACTIVE
8/16/2013 None
N/A
DALLAS
TX
ACTIVE
TEXAS
LICENSE
ISSUED
12/19/2011 None
N/A
5/16/2011 None
N/A
ACTIVE
3/19/2013 None
N/A
ACTIVE
8/14/2013 None
N/A
ACTIVE
11/22/2011 None
N/A
ACTIVE
11/11/2011 None
N/A
ACTIVE
4/23/2010 None
N/A
ACTIVE
8/23/2011 None
N/A
ACTIVE
3/20/2012 None
N/A
MCKINNEY
TX
PEDIATRIC
ORTHOPEDICS
SPORTS MEDICINE
(ORTH SURG)
Registration
Status Date
Disciplinary
Status of
Texas
License
BRYAN
TX
ORTHOPEDIC
SURGERY
ORTHOPEDIC
SURGERY
ROCKWALL
TX
ACTIVE
12/3/2010 None
N/A
ORTHOPEDIC
SURGERY
PLANO
TX
ACTIVE
4/27/2010 None
N/A
2/5/2010 None
N/A
ORTHOPEDIC
SURGERY
Page 217 of 301
LICENSE
ISSUED
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
SURGERY OF THE
ORTHOPEDIC
P1389
PRASARN, MARK LAWRENCE, MD
11/4/2011
11/4/2016 SPINE
TRAUMA
ORTHOPEDIC
SURGERY OF THE
N5992
SAMOCHA, YIGAL, MD
4/9/2010
4/9/2015 SPINE
ORTHOPEDIC
SURGERY OF THE
ORTHOPEDIC
L7160
SANTMAN, MARK, MD
9/17/2012
9/17/2017 SPINE
SURGERY
ORTHOPEDIC
SURGERY OF THE
ORTHOPEDIC
N8722
SHAH, NEIL DILIP, MD
2/4/2011
2/4/2016 SPINE
SURGERY
ORTHOPEDIC
SURGERY OF THE
P5572
STOUFFER, MARK HAROLD, MD
2/8/2013
2/8/2018 SPINE
ORTHOPEDIC
SURGERY OF THE
ORTHOPEDIC
N7499
THONGTRANGAN, ISSADA, MD
8/16/2010
8/16/2015 SPINE
SURGERY
ORTHOPEDIC
SURGERY OF THE
N8865
UGHWANOGHO, EJOVI, MD
2/15/2011
2/15/2016 SPINE
ORTHOPEDIC
N4231
ACHOR, TIMOTHY STUART, MD
11/6/2009
11/6/2014 TRAUMA
ORTHOPEDIC
ORTHOPEDIC
N0606
ANDERSON, CODY NEAL, MD
8/29/2008
8/29/2013 TRAUMA
SURGERY
ORTHOPEDIC
N3488
BAUER, BRENT J, MD
8/21/2009
8/21/2014 TRAUMA
ORTHOPEDIC
ORTHOPEDIC
N9364
DOMBROSKI, DEREK GEORGE, MD
4/8/2011
4/8/2016 TRAUMA
SURGERY
ORTHOPEDIC
ORTHOPEDIC
P6182
HILL, AUSTIN D, MD
4/12/2013
4/12/2018 TRAUMA
SURGERY
ORTHOPEDIC
ORTHOPEDIC
N9376
HOLLAND, DANNY CARL, DO
4/8/2011
4/8/2016 TRAUMA
SURGERY
ORTHOPEDIC
ORTHOPEDIC
N6955
PATEL, SAILA, DO
7/1/2010
7/1/2015 TRAUMA
SURGERY
ORTHOPEDIC
N1872
SABLAN, MARIO KEKONA, DO
12/12/2008 12/12/2013 TRAUMA
ORTHOPEDIC
ORTHOPEDIC
P1597
SPARKS, CHARISSE YVETTE, MD
12/1/2011
12/1/2016 TRAUMA
SURGERY
ORTHOPEDIC
N9313
SWANSON, ELI, MD
4/1/2011
4/1/2016 TRAUMA
ORTHOPEDICS
Page 218 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
11/16/2011 None
N/A
PLANO
TX
ACTIVE
4/19/2010 None
N/A
ROUND ROCK TX
ACTIVE
10/5/2012 None
N/A
LICENSE
ISSUED
2/4/2011 None
N/A
LICENSE
ISSUED
2/8/2013 None
N/A
ACTIVE
8/25/2010 None
N/A
LICENSE
ISSUED
2/15/2011 None
N/A
PLANO
TX
HOUSTON
TX
ACTIVE
11/20/2009 None
N/A
HOUSTON
TX
ACTIVE
9/11/2008 None
N/A
PLANO
TX
ACTIVE
9/3/2009 None
N/A
DALLAS
TX
ACTIVE
5/2/2011 None
N/A
AUSTIN
TX
ACTIVE
4/26/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
4/15/2011 None
N/A
7/1/2010 None
N/A
ACTIVE
1/1/2009 None
N/A
ACTIVE
12/6/2011 None
N/A
ACTIVE
4/11/2011 None
N/A
DALLAS
HOUSTON
TX
CA
License
Number
Physician Name
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
ORTHOPEDIC
8/15/2011
8/15/2016 TRAUMA
SURGERY
ORTHOPEDIC
7/15/2011
7/15/2016 TRAUMA
P0804
TURNBOW, BENJAMIN , MD
P0524
ZELLE, BORIS ALEXANDER, MD
N4311
BROCK, ERIC RANDALL, MD
P1175
P5800
COWDEN, COURTNEY HOLT III, MD
ELLISON, KEITH TAYLOR, MD
P6169
4/12/2013
N5135
GARZA, RALPH ZACHARY, MD
JORDAN, WILLIAM JEFFERSON,
MD
2/5/2010
P6668
KUHNS, CRAIG ALLEN, MD
5/15/2013
P4983
N8128
MILLER, RYAN BRYCE, MD
MURRAY, MATTHEW CHARLES,
MD
P5855
N5918
NGUYEN, MICHAEL LY, MD
OJEYEMI, DAPO, MD
3/15/2013
4/9/2010
P4495
P5700
ONYIKE, AHAM ELEMUWA, MD
OVERTURF, STEVEN , MD
PATEL, VISHAL CHANDRAKANT,
MD
SMITH, TODD BENEDICT, MD
STANLEY, JAY MICHAEL, MD
9/17/2012
3/1/2013
3/1/2013
10/1/2012
4/9/2010
P5705
P4615
N6040
11/6/2009
10/17/2011 10/17/2016 ORTHOPEDICS
3/15/2013
11/15/2010 11/15/2015 ORTHOPEDICS
WEBER, IAN CHARLES, MD
3/1/2012
P5502
ZIDE, JACOB ROTHSCHILD, MD
2/1/2013
N6158
N7796
WALSH, RALPH CLAIBORNE JR,
DO
BALLIVIAN, ROBERTO
ALEJANDRO, MD
FRIERSON, SABRINA DEBRA
TRIEFF, MD
GALVESTON
1/18/2011
SPORTS MEDICINE
(ORTH SURG)
ORTHOPEDIC
TRAUMA
FOOT AND ANKLE,
ORTHOPEDICS
FP/OSTEO
OSTEO MANIPULATIVE MANIPULATION
1/18/2016 MEDICINE
MEDICINE
6/4/2010
6/4/2015 OTHER SPECIALTY
10/1/2010
Disciplinary
Status Date
ACTIVE
8/22/2011 None
N/A
SAN ANTONIO TX
MINERAL
WELLS
TX
ACTIVE
7/20/2011 None
N/A
ACTIVE
11/13/2009 None
N/A
KANSAS CITY MO
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
11/9/2011 None
4/11/2013 None
N/A
N/A
4/12/2013 None
N/A
2/5/2010 None
N/A
5/15/2013 None
N/A
11/30/2012 None
N/A
12/14/2010 None
N/A
BIRMINGHAM
AL
ACTIVE
BEDFORD
TX
ACTIVE
ACTIVE
DELINQUEN
T-NON
PAYMENT
ACTIVE
4/15/2013 None
4/27/2010 None
N/A
N/A
12/16/2012 None
4/2/2013 None
N/A
N/A
AUSTIN
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
3/4/2013 None
10/15/2012 None
4/26/2010 None
N/A
N/A
N/A
OMAHA
NE
ACTIVE
3/23/2012 None
N/A
BALTIMORE
MD
ACTIVE
2/5/2013 None
N/A
AKRON
OH
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/26/2011 None
N/A
6/4/2010 None
N/A
10/1/2010 None
N/A
MARSHALL
Page 219 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
11/30/2012 11/30/2017 ORTHOPEDICS
P2396
J9427
Practice City
Registration
Status of
Practice
Texas
State
License
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N5686
GEORGE, SANDY, MD
4/9/2010
P6236
PALM, DANIEL BRIAN, MD
4/12/2013
P3454
N3468
SMYTH, MICHAEL HENRY, MD
BADI, ARUNKUMAR NARAYANSA ,
MD
8/21/2009
N3480
BARRERA, JOSE ENRIQUE, MD
8/21/2009
N3609
DEMKE, JOSHUA CHARLES, MD
8/21/2009
N8230
NGUYEN, NINH HAM, DO
12/1/2010
N5383
SAWHNEY, RAJA, MD
6/1/2012
N7596
P3277
VAYSBERG, MIKHAIL, DO
ALEXANDER, IAN J, MD
8/27/2010
6/1/2012
OTOLARYN & FACIAL
8/21/2014 PLASTIC SURGERY
OTOLARYN & FACIAL
OTOLARYN & FACIAL
OTOLARYN & FACIAL
OTOLARYN & FACIAL
OTOLARYN & FACIAL
6/1/2017 OTOLARYNGOLOGY
N9159
ALLEN, KYLE PIERCE, MD
4/1/2011
N5534
N8613
ANDREWS, GENEVIEVE ANN, MD
BEDNARSKI, KAREN ANNE, MD
4/9/2010
2/4/2011
N9354
BERRYHILL, WAYNE EDWARD, MD
4/8/2011
P0015
BYRD, MICHAEL CHARLES, MD
6/15/2011
P6597
CHEN, PHILIP, MD
5/15/2013
N5629
CILENTO, BENJAMIN WEST, MD
4/9/2010
N9533
P0970
DAMMERT, MARK OLIVER, MD
DEAN, MARC RICHARD, MD
5/2/2011
9/15/2011
P3141
P3333
DECKARD, NATHAN ALLEN, MD
GLASS, DANIEL ADAM, MD
5/15/2012
6/1/2012
2/5/2010
Secondary Specialty
(Self-Designated)
UNDERSEA AND
HYPERBARIC MED
(PREV MED)
Practice City
FAMILY MEDICINE
OBSTETRICS AND
GYNECOLOGY
OTOLOGY/NEUTOTO
LOGY
MONROE
SLEEP MEDICINE
CRANIOFACIAL
SURGERY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/9/2010 None
N/A
4/12/2013 None
N/A
6/1/2012 None
N/A
ACTIVE
10/1/2009 None
N/A
SAN ANTONIO TX
ACTIVE
8/26/2009 None
N/A
LUBBOCK
TX
ACTIVE
9/25/2009 None
N/A
WARREN
MI
12/14/2010 None
N/A
2/5/2010 None
N/A
NM
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
8/27/2010 None
6/13/2012 None
N/A
N/A
TX
ACTIVE
4/5/2011 None
N/A
TX
NC
ACTIVE
ACTIVE
4/19/2010 None
2/11/2011 None
N/A
N/A
OK
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/27/2011 None
N/A
6/15/2011 None
N/A
5/15/2013 None
N/A
TX
ACTIVE
4/15/2010 None
N/A
TX
ACTIVE
ACTIVE
5/5/2011 None
12/8/2011 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
5/16/2012 None
6/8/2012 None
N/A
N/A
LOS ALAMOS
OTOLOGY/NEUTOTO
LOGY
DALLAS
HOUSTON
RALEIGH
OTOLOGY/NEUTOTO
LOGY
NORMAN
SAN ANTONIO TX
OTOLARYN & FACIAL
PLASTIC SURGERY
HOUSTON
FACIAL PLASTIC
SURGERY
FORT WORTH
URGENT CARE
MEDICINE
DALLAS
TYLER
Page 220 of 301
Disciplinary
Status Date
LA
HEAD AND NECK
SURGERY
RHINOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N8514
GRISEL, JEDIDIAH JAMES, MD
N8298
P5278
GUILLORY, RYAN MARTIN, MD
HATCHER, JEANNE LEIGH, MD
LARRISON, DEBORAH MARLAINE,
MD
LASITER, JOHN CLINTON, MD
LEE, PAUL STEVEN, MD
12/15/2010 12/15/2015 OTOLARYNGOLOGY
1/15/2013
12/12/2008 12/12/2013 OTOLARYNGOLOGY
P2311
MAKISHIMA, TOMOKO , MD
MUKERJI, SHRADDHA SIDDHARTH,
MD
P6224
NASON, ROBERT, MD
P5560
N2246
P0655
N9086
N4538
P0081
N1752
1/18/2011
3/15/2011
11/6/2009
6/15/2011
4/12/2013
PHAM, VIET HOAI, MD
PINE, HAROLD SCOTT, MD
2/8/2013
2/6/2009
POSS, JAMES MATTHEW, MD
POWITZKY, ROSSER KENNEDY,
MD
8/1/2011
3/1/2013
6/1/2012
5/15/2012
N4074
P0493
P5131
P5131
P5131
RIDLEY, RYAN WINTRELL, MD
RIHANI, JORDAN JOSEPH, MD
SCHMALBACH, CECELIA
ELIZABETH , MD
SEWELL, STEVEN KENNETH, MD
SHAH, GOPI BIPIN, MD
N5401
SILLER, SUZEL F, MD
P3424
P3234
8/21/2009
7/15/2011
12/17/2012 12/17/2017 OTOLARYNGOLOGY
12/17/2012 12/17/2017 OTOLARYNGOLOGY
12/17/2012 12/17/2017 OTOLARYNGOLOGY
2/5/2010
Practice City
WICHITA
FALLS
OTORHINOLARYNGO
LOGY
PEDIATRIC
OTOLARYNGOLOGY
PEDIATRIC
OTOLARYNGOLOGY
OTORHINOLARYNGO
LOGY
PEDIATRIC
OTOLARYNGOLOGY
HEAD AND NECK
SURGERY
SLEEP MEDICINE
N9309
P7367
STURM-O'BRIEN, ANGELA KAY, MD
WALGAMA, EVAN SANATH, MD
4/1/2011
7/15/2013
P0515
P6555
WATTS, TAMMARA LYNN, MD
WU, JONATHAN, MD
7/15/2011
5/1/2013
Disciplinary
Status Date
ACTIVE
1/26/2011 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
12/21/2010 None
1/31/2013 None
N/A
N/A
SOUTHLAKE
COLUMBIA
TX
MO
ACTIVE
ACTIVE
ACTIVE
3/29/2011 None
12/22/2009 None
6/21/2011 None
N/A
N/A
N/A
GALVESTON
TX
ACTIVE
12/17/2008 None
N/A
GALVESTON
TX
ACTIVE
3/12/2012 None
N/A
AUSTIN
TX
ACTIVE
4/23/2013 None
N/A
GALVESTON
GALVESTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
2/20/2013 None
3/26/2009 None
N/A
N/A
8/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
3/8/2013 None
N/A
6/1/2012 None
5/22/2012 None
N/A
N/A
MINNEAPOLIS MN
SAN ANTONIO
LEESVILLE
NASHVILLE
NASHVILLE
NASHVILLE
TX
LA
TN
TN
TN
FACIAL PLASTIC
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
OTOLARYNGIC
ALLERGY
3/1/2012
P5710
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
8/31/2009
8/1/2011
12/21/2012
12/21/2012
12/21/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
2/5/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
4/11/2011 None
7/31/2013 None
N/A
N/A
OTOLARYN & FACIAL
PLASTIC SURGERY
GALVESTON TX
FORT WORTH TX
ACTIVE
ACTIVE
8/9/2011 None
5/6/2013 None
N/A
N/A
Page 221 of 301
HOUSTON
DALLAS
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P5763
YAVROUIAN, ERIC JOHN, MD
N7893
edicaid
edicaid
End Date
Designated)
3/1/2013
YOUNG, DAYTON LEONARD, MD
10/1/2010
P7873
YUKSEL, SANCAK , MD
8/30/2013
P6824
GUPTA, SACHIN, MD
P7018
PFANNENSTIEL, TRAVIS JOHN, MD
6/14/2013
P6122
ALAVA, IBRAHIM III, MD
4/12/2013
P5926
ANTUNES, MARCELO BARROS, MD
P4845
AYALA, CARLOS, MD
P2593
BERG, ERIC E, MD
OTOLARYNGOLOGY
6/3/2018 (NEUROTOLOGY)
OTOLARYNGOLOGY
6/14/2018 (NEUROTOLOGY)
OTORHINOLARYNGOL
4/12/2018 OGY
OTORHINOLARYNGOL
4/1/2018 OGY
OTORHINOLARYNGOL
11/15/2017 OGY
OTORHINOLARYNGOL
4/2/2017 OGY
6/3/2013
4/1/2013
11/15/2012
4/2/2012
P3515
BOAHENE, DEREK KOFI OWUSU,
MD
BOWEN, REBECCA CATHERINE,
MD
CAPERTON, KIMBERLY KRISTA,
MD
P1281
CHATER, MICHAEL GEORGE, MD
11/4/2011
N8175
CLARK, DAVID WELLES, MD
12/1/2010
N8888
P3291
3/1/2011
6/1/2012
6/8/2012
P7624
CONTRERAS, JORGE IVAN, MD
8/15/2013
N9551
GELFAND, YURI MICHAEL, MD
5/2/2011
N3062
GUNGOR, ANIL ABDULLAH, MD
5/29/2009
N2103
HALES, NATHAN WAYNE, MD
2/6/2009
P7468
HU, MELISSA, MD
8/1/2013
OTORHINOLARYNGOL
3/1/2016 OGY
OTORHINOLARYNGOL
6/1/2017 OGY
OTORHINOLARYNGOL
6/8/2017 OGY
OTORHINOLARYNGOL
11/4/2016 OGY
OTORHINOLARYNGOL
12/1/2015 OGY
OTORHINOLARYNGOL
8/15/2018 OGY
OTORHINOLARYNGOL
5/2/2016 OGY
OTORHINOLARYNGOL
5/29/2014 OGY
OTORHINOLARYNGOL
2/6/2014 OGY
Secondary Specialty
(Self-Designated)
Practice City
OTOLARYN & FACIAL
PLASTIC SURGERY
OTOLOGY/NEUTOTO
LOGY
BERTHOUD
PEDIATRIC
OTOLARYNGOLOGY HOUSTON
OTOLOGY/NEUTOTO
LOGY
DALLAS
FORT SAM
OTOLARYNGOLOGY
FACIAL PLASTIC
SURGERY
FACIAL PLASTIC
SURGERY
Registration
Status of
Practice
Texas
State
License
OTOLARYNGIC
ALLERGY
OTOLARYNGOLOGY
PEDIATRIC
OTOLARYNGOLOGY
HEAD AND NECK
SURGERY
OTORHINOLARYNGOL OTOLARYN & FACIAL
8/1/2018 OGY
PLASTIC SURGERY
Page 222 of 301
Disciplinary
Status Date
ACTIVE
3/19/2013 None
N/A
CO
ACTIVE
10/20/2010 None
N/A
TX
ACTIVE
9/2/2013 None
N/A
TX
ACTIVE
6/5/2013 None
N/A
TX
ACTIVE
6/24/2013 None
N/A
HOUSTON
TX
ACTIVE
4/16/2013 None
N/A
ROCHESTER
NY
ACTIVE
4/3/2013 None
N/A
ACTIVE
11/19/2012 None
N/A
ACTIVE
4/9/2012 None
N/A
LICENSE
ISSUED
3/1/2011 None
N/A
SAN ANTONIO TX
ACTIVE
6/7/2012 None
N/A
LAFAYETTE
CO
ACTIVE
6/27/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
11/15/2011 None
N/A
12/1/2010 None
N/A
ACTIVE
8/16/2013 None
N/A
ACTIVE
5/5/2011 None
N/A
TX
ACTIVE
6/15/2009 None
N/A
SAN ANTONIO TX
ACTIVE
2/12/2009 None
N/A
8/1/2013 None
N/A
OTOLARYN & FACIAL
PLASTIC SURGERY
RHINOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
EL PASO
TEMPLE
TX
LICENSE
ISSUED
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
OTORHINOLARYNGOL
P2701
KHAN, AAYESHA MUMTAZ, MD
4/2/2012
4/2/2017 OGY
OTORHINOLARYNGOL
P2024
KRESS, MELISSA GALE, DO
2/1/2012
2/1/2017 OGY
OTORHINOLARYNGOL
N9268
MILOV, SIMON, MD
4/1/2011
4/1/2016 OGY
OTORHINOLARYNGOL
H5202
ROSANE, BRET, MD
4/12/2013
4/12/2018 OGY
OTORHINOLARYNGOL
P0525
ZEVALLOS, JOSE PEDRO, MD
7/15/2011
7/15/2016 OGY
OTORHINOLARYNGOL
P0527
ZHOU, CONSTANCE QINGYUN, MD
7/15/2011
7/15/2016 OGY
P4415
P7072
BABADE, MOSUNMOLA , MD
BERRY, THOMAS JOEL, MD
9/17/2012
7/1/2013
P2622
4/2/2012
P0821
COOPER, DAVID M, MD
CREIGHTON, CHRISTOPHER
PRICE, MD
8/26/2011
P0578
P4678
EL-BAGHDADI, MARIAM MAHDI, MD
MEHTA, PANKAJ, MD
N9002
TRAN, ALEX MINH NGUYET, MD
3/1/2011
N8472
WYCKOFF, SHAMOLIE NICOLE, MD
1/3/2011
N6200
BURNETTE, CANDICE A, MD
6/4/2010
N4346
CHOUDHRI, MOBEEN NAEEM, MD
11/6/2009
N2473
DOPPALAPUDI, HIMA SUDHA, MD
4/3/2009
N6287
EZEKIEL, BENNETT JOHN, MD
6/4/2010
8/1/2011
10/15/2012 10/15/2017 PAIN MANAGEMENT
Secondary Specialty
(Self-Designated)
OTOLARYNGOLOGY
PEDIATRIC
OTOLARYNGOLOGY
HEAD AND NECK
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
4/16/2012 None
N/A
2/1/2012 None
N/A
TX
ACTIVE
4/6/2011 None
N/A
ANCHORAGE
AK
ACTIVE
4/15/2013 None
N/A
HOUSTON
TX
ACTIVE
8/9/2011 None
N/A
TX
ACTIVE
7/27/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
10/3/2012 None
7/3/2013 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
4/5/2012 None
N/A
8/26/2011 None
N/A
ACTIVE
ACTIVE
8/11/2011 None
10/31/2012 None
N/A
N/A
ACTIVE
3/22/2011 None
N/A
ACTIVE
2/1/2011 None
N/A
PAIN MEDICINE
ANESTHESIOLOGY
SPRINGFIELD MA
PHYSICAL MED. &
REHABILITATION
TAMPA
FL
PAIN
MANAGEMENT/REHA
B MED
PLANTATION FL
Page 223 of 301
Disciplinary
Status Date
HARLINGEN
IRVING
ANESTHESIOLOGY PAIN MANAGEMENT PLANO
ANESTHESIOLOGY
BELLAIRE
PAIN
MANAGEMENT/REHA
B MED
ROCKWALL
PAIN
MANAGEMENT/REHAB
6/4/2015 MED
PAIN
MANAGEMENT/REHAB
11/6/2014 MED
PAIN MANAGEMENT
PAIN
MANAGEMENT/REHAB
4/3/2014 MED
PAIN
MANAGEMENT/REHAB
6/4/2015 MED
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
6/4/2010 None
SEE
PREVIOUS
11/16/2009 ORDER
N/A
11/9/2009
6/29/2009 None
N/A
6/4/2010 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
PAIN
MANAGEMENT/REHAB
11/6/2009
11/6/2014 MED
PAIN
MANAGEMENT/REHAB
8/15/2011
8/15/2016 MED
PAIN
MANAGEMENT/REHAB
1/15/2013
1/15/2018 MED
PAIN
MANAGEMENT/REHAB
5/29/2009
5/29/2014 MED
PAIN
MANAGEMENT/REHAB
6/3/2011
6/3/2016 MED
PAIN
MANAGEMENT/REHAB
12/12/2008 12/12/2013 MED
PAIN
MANAGEMENT/REHAB
2/5/2010
2/5/2015 MED
8/29/2008
8/29/2013 PAIN MEDICINE
N4446
GUPTA, MANU, MD
P0733
HUME, JOHN WESTMORELAND,
MD
P5291
MCMILLEN, THURSTON DRU, MD
N3195
MUKAI, AI , MD
N9930
PENCE, BENJAMIN TIM, DO
N1850
RAY, THADDEUS ALEXAS, DO
L3143
N0928
STEPHENS, CHAD BRYAN, DO
LINN, ANDREW , MD
P6463
MCLAUGHLIN, MICHAEL PAUL, DO
5/1/2013
P7159
MCLEOD, MICHAEL PAUL, MD
7/1/2013
P3209
P0646
5/15/2012
8/1/2011
P7527
N4691
NAGPAL, AMEET SINGH, MD
ODELL, ROBERT H JR, MD
ORILLOSA, SUSAN JEDA
DOLLOSA, MD
RANDALL, STEVE ERIC, MD
8/1/2013
11/6/2009
P7843
RIXTER, DAVIDA DENISE, MD
8/30/2013
P6330
AZHAR, AHSAN , MD
N7071
CINTRON, ALEXIE, MD
N6226
CLEMENS, MARK WARREN II, DO
5/1/2013
7/15/2010
6/4/2010
Secondary Specialty
(Self-Designated)
Practice City
FORT MYERS
Registration
Status of
Practice
Texas
State
License
GA
SPORTS MEDICINE REHAB MED
PAIN MEDICINE
AUSTIN
TX
SPINAL CORD
INJURY MEDICINE
PHYSICAL MED. &
REHABILITATION
DES MOINES
IA
SPORTS MEDICINE
(FAMILY PRACTICE)
ANESTHESIOLOGY
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
ANESTHESIOLOGY
SPORTS MEDICINE
OKLAHOMA
CITY
CORPUS
CHRISTI
6/4/2015 PALLIATIVE MEDICINE
Page 224 of 301
Disciplinary
Status Date
ACTIVE
12/1/2009 None
N/A
ACTIVE
8/23/2011 None
N/A
LICENSE
ISSUED
1/15/2013 None
N/A
ACTIVE
6/4/2009 None
N/A
LICENSE
ISSUED
6/3/2011 None
N/A
2/23/2009 None
N/A
2/5/2010 None
10/20/2008 None
N/A
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
OK
ACTIVE
5/30/2013 None
N/A
TX
ACTIVE
7/15/2013 None
N/A
HOUSTON
TX
FORT WORTH TX
ACTIVE
ACTIVE
5/22/2012 None
8/8/2011 None
N/A
N/A
WEBSTER
FT. WORTH
ACTIVE
ACTIVE
LICENSE
ISSUED
8/2/2013 None
11/13/2009 None
N/A
N/A
8/30/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/19/2013 None
N/A
7/15/2010 None
N/A
6/4/2010 None
N/A
5/1/2018 PALLIATIVE MEDICINE INTERNAL MEDICINE HOUSTON
7/15/2015 PALLIATIVE MEDICINE INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
P0377
DUMLAO, DONATO GAERLAN, MD
N1626
ETIENNE, ABDIAS DEMETREE, MD
N6921
MASTERSON, JESSICA , MD
G0269
P7735
WAUGH, DENISE GAYLE, MD
ALI, SARFRAZ, MD
EMERGENCY
10/29/2010 10/29/2015 PALLIATIVE MEDICINE MEDICINE
8/30/2013
8/30/2018 PATHOLOGY
CYTOPATHOLOGY
H6762
AMBERGER, DAVID MARCUS, MD
12/15/2010 12/15/2015 PATHOLOGY
P1732
P5607
CANACCI, ANASTASIA MARIE, MD
CHEN, XIANGBAI , MD
1/2/2012
3/1/2013
1/2/2017 PATHOLOGY
3/1/2018 PATHOLOGY
N6843
N5636
COLE, RYAN NEIL, MD
CONTRERAS, ALEJANDRO , MD
7/1/2010
4/9/2010
7/1/2015 PATHOLOGY
4/9/2015 PATHOLOGY
N2463
DAVIE, JAMES ROBERT , MD
4/3/2009
4/3/2014 PATHOLOGY
N4389
DUMAS, ALAIN , MD
11/6/2009
11/6/2014 PATHOLOGY
H8635
P1640
FARHI, DIANE C, MD
FAROUSSI, SAWSAN, MD
N6291
FELIX, JUAN CARLOS, MD
6/4/2010
6/4/2015 PATHOLOGY
N2082
GARCIA, JULIAN ALBERT, MD
2/6/2009
2/6/2014 PATHOLOGY
P7274
GEORGE, ELIAS RODRIGUEZ, MD
7/15/2013
7/15/2018 PATHOLOGY
P6400
GOSWAMI, AARTI, MD
5/1/2013
5/1/2018 PATHOLOGY
P3161
GUO, MEIHUA , MD
5/15/2012
5/15/2017 PATHOLOGY
N7097
HAAS, ROBERT JUNIUS JR, MD
7/15/2010
7/15/2015 PATHOLOGY
N7806
HARRIS, JAMES BRENT, MD
Practice City
7/15/2011
7/15/2016 PALLIATIVE MEDICINE INTERNAL MEDICINE KINGWOOD
PALLIATIVE
12/12/2008 12/12/2013 PALLIATIVE MEDICINE MEDICINE
EDINBURG
7/1/2010
10/1/2010
10/1/2015 PATHOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
7/21/2011 None
N/A
TX
ACTIVE
3/2/2009 None
N/A
DALLAS
TX
7/12/2010 None
N/A
TEMPLE
CRANFORD
TX
NJ
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
10/29/2010 None
9/9/2013 None
N/A
N/A
DERMOPATHOLOGY HONOLULU
HI
ACTIVE
12/21/2010 None
N/A
2/24/2012 None
3/11/2013 None
N/A
N/A
7/1/2010 None
5/3/2010 None
N/A
N/A
4/14/2009 None
N/A
11/17/2009 None
N/A
2/4/2011 None
12/20/2011 None
N/A
N/A
6/4/2010 None
N/A
7/1/2015 PALLIATIVE MEDICINE ONCOLOGY
2/4/2011
2/4/2016 PATHOLOGY
12/15/2011 12/15/2016 PATHOLOGY
Registration
Status of
Practice
Texas
State
License
CYTOPATHOLOGY
DERMATOPATHOLO
GY
DERMATOPATHOLO
GY
DERMATOPATHOLO
GY
CYTOPATHOLOGY
CYTOPATHOLOGY
DERMATOPATHOLO
GY
HEMATOLOGY
(PATHOLOGY)
HEMATOLOGY
(PATHOLOGY)
HEMATOLOGY
(PATHOLOGY)
Page 225 of 301
CARROLLTON TX
TEMPLE
TX
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
SHELTON
CT
DALLAS
JACKSON
TX
MS
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
2/13/2009 None
N/A
HARLINGEN
TX
ACTIVE
7/25/2013 None
N/A
NEW YORK
NY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/2/2013 None
N/A
5/15/2012 None
N/A
7/15/2010 None
N/A
10/13/2010 None
N/A
TORRANCE
CA
ACTIVE
License
Number
Physician Name
P6979
HU, SHIMIN, MD
N5122
N7820
ILASI, JOSEPH ANTHONY , DO
KARPOWICZ, MATTHEW
KORNELIUSZ, DO
P0245
edicaid
edicaid
End Date
Designated)
6/14/2013
6/14/2018 PATHOLOGY
2/5/2010
2/5/2015 PATHOLOGY
10/1/2010
10/1/2015 PATHOLOGY
KINGMA, DOUGLAS WILLIAM, MD
7/1/2011
7/1/2016 PATHOLOGY
N3801
P0751
KSHIRSAGAR, MALTI PATHAK, MD
LARSEN, DOUGLAS ALAN, MD
8/21/2009
8/15/2011
8/21/2014 PATHOLOGY
8/15/2016 PATHOLOGY
P2479
N4549
N6913
LEI, JUNYI , MD
LEONARD, RONALD L., DO
LIU, JING, MD
3/15/2012
11/6/2009
7/1/2010
3/15/2017 PATHOLOGY
11/6/2014 PATHOLOGY
7/1/2015 PATHOLOGY
N8809
LUCAS, ELENA , MD
2/15/2011
2/15/2016 PATHOLOGY
N6466
LUU, HUNG S, MD
P5415
N3863
P0996
MANN, SHANNON ELIZABETH, DO
MAO, QINWEN , MD
MASAND, RAMYA PRAKASH, MD
N8042
N4588
MILLER, BRADLEY BRYAN, MD
MILLER, JEREMY SCOTT , MD
N5248
MIRMOW, DWIGHT PAUL, MD
MONAGHAN, SARA ANTOINETTE,
MD
MONFORD, DIANE KAY, MD
N9749
P0767
P0771
F1170
P5697
NEDELCU, ELENA , MD
NEWBERRY, ROBERT CARROLL,
MD
OKOYE, EKENE IFEYINWA, MD
6/4/2010
6/4/2015 PATHOLOGY
2/1/2013
8/21/2009
9/15/2011
2/1/2018 PATHOLOGY
8/21/2014 PATHOLOGY
9/15/2016 PATHOLOGY
10/29/2010 10/29/2015 PATHOLOGY
11/6/2009
11/6/2014 PATHOLOGY
2/5/2010
Secondary Specialty
(Self-Designated)
HEMATOLOGY
(PATHOLOGY)
CYTOPATHOLOGY
PATHOLOGY
Practice City
HOUSTON
AUSTIN
TEMPLE
COLLEGEVILL
E
PARSONS
UNIONDALE
Registration
Status of
Practice
Texas
State
License
TX
6/21/2013 None
N/A
2/5/2010 None
N/A
10/1/2010 None
N/A
7/1/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
8/31/2009 None
8/18/2011 None
N/A
N/A
PA
KS
NY
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/22/2012 None
11/12/2009 None
7/16/2010 None
N/A
N/A
N/A
2/15/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/14/2013 None
8/26/2009 None
9/20/2011 None
N/A
N/A
N/A
10/29/2010 None
11/17/2009 None
N/A
N/A
2/5/2010 None
N/A
DALLAS
HOUSTON
TX
TX
AUGUSTA
GA
LABORATORY
MEDICINE
2/5/2015 PATHOLOGY
5/16/2011
8/15/2011
5/16/2016 PATHOLOGY
8/15/2016 PATHOLOGY
8/15/2011
8/15/2016 PATHOLOGY
8/16/2010
3/1/2013
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HEMATOLOGY
(PATHOLOGY)
HEMATOLOGY
(PATHOLOGY)
CYTOPATHOLOGY
HEMATOLOGY
(PATHOLOGY)
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
ACTIVE
ACTIVE
5/20/2011 None
8/22/2011 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/23/2011 None
N/A
8/16/2015 PATHOLOGY
3/1/2018 PATHOLOGY
FRISCO
HOUSTON
TX
TX
ACTIVE
ACTIVE
9/23/2010 None
3/11/2013 None
N/A
N/A
BLOOD
BANKING/TRANSFUSI
ON MEDICINE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
8/19/2013 None
N/A
6/4/2010 None
N/A
P7523
O'LEARY, MANDY FLANNERY, MD
8/1/2013
8/1/2018 PATHOLOGY
N6561
PARK, JASON YOUNG, MD
6/4/2010
6/4/2015 PATHOLOGY
DALLAS
Page 226 of 301
TX
License
Number
N7325
N9764
N1839
Physician Name
PATEL, SUKETU, DO
PENG, LAN , MD
POWERS, MICHELLE LEIGH
EHRLICH, MD
edicaid
edicaid
End Date
Designated)
8/2/2010
5/16/2011
8/2/2015 PATHOLOGY
5/16/2016 PATHOLOGY
12/12/2008 12/12/2013 PATHOLOGY
P2510
PURAYIDOM, ANNILYN S, MD
3/15/2012
3/15/2017 PATHOLOGY
N8563
1/18/2011
1/18/2016 PATHOLOGY
N2752
RAI, HAR PRATAP, MD
RECAVARREN ASENCIOS,
ROSEMARY ABIGAIL, MD
4/3/2009
4/3/2014 PATHOLOGY
N9126
N8460
SHAFI, NADIYA BABAR, MD
SI, QIUSHENG , MD
3/15/2011
1/3/2011
3/15/2016 PATHOLOGY
1/3/2016 PATHOLOGY
P5006
N6681
N3331
N4138
SPEARS, MICHAEL DON, MD
STAGGS, BRENT CHRISTOPHER,
MD
STARLING, CHERRY ELIZABETH,
MD
STRAUSS, BRIAN LOUIS, MD
SU, MU , MD
N4772
SUSSMAN, ZACHARY MICHAEL, MD
N5425
P5750
N9991
P1245
TADROS, YOUSEF EBEID , MD
UDDIN, NASEEM , MD
WAGAR, ELIZABETH ANN, MD
WANG, GORDON GUAN, MD
N1216
WANG, SA , MD
8/29/2008
8/29/2013 PATHOLOGY
N9146
N4865
P7232
WILLIS, JASON SCOTT, MD
YU, MUJUN, MD
ZHANG, MIAO, MD
3/15/2011
11/6/2009
7/1/2013
3/15/2016 PATHOLOGY
11/6/2014 PATHOLOGY
7/1/2018 PATHOLOGY
N8599
ZHANG, SONGLIN, MD
1/18/2011
1/18/2016 PATHOLOGY
P7875
ZHANG, WEI, MD
8/30/2013
8/30/2018 PATHOLOGY
P7211
Secondary Specialty
(Self-Designated)
DERMATOPATHOLO
GY
11/30/2012 11/30/2017 PATHOLOGY
7/1/2013
7/1/2018 PATHOLOGY
6/4/2010
5/29/2009
8/21/2009
6/4/2015 PATHOLOGY
5/29/2014 PATHOLOGY
8/21/2014 PATHOLOGY
11/6/2009
11/6/2014 PATHOLOGY
2/5/2010
2/5/2015
3/1/2013
3/1/2018
6/3/2011
6/3/2016
10/17/2011 10/17/2016
Practice City
Registration
Status of
Practice
Texas
State
License
TX
MA
ACTIVE
ACTIVE
8/23/2010 None
5/25/2011 None
N/A
N/A
ST. LOUIS
MO
ACTIVE
12/24/2008 None
N/A
ACTIVE
LICENSE
ISSUED
3/23/2012 None
N/A
1/18/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/8/2009 None
N/A
3/15/2011 None
1/13/2011 None
N/A
N/A
MINNEAPOLIS MN
ACTIVE
12/4/2012 None
N/A
LITTLE ROCK
AR
7/3/2013 None
N/A
LAS VEGAS
DALLAS
NV
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/4/2010 None
6/29/2009 None
8/31/2009 None
N/A
N/A
N/A
ROSWELL
NM
11/18/2009 None
N/A
DALLAS
HOUSTON
DALLAS
TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
2/5/2010
3/8/2013
6/10/2011
11/11/2011
None
None
None
None
N/A
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
9/18/2008 None
N/A
DALLAS
ROSWELL
HOUSTON
TX
NM
TX
ACTIVE
ACTIVE
ACTIVE
3/29/2011 None
11/19/2009 None
8/5/2013 None
N/A
N/A
N/A
2/1/2011 None
N/A
8/30/2013 None
N/A
EDINBURG
TX
CYTOPATHOLOGY
PATHOLOGY
PATHOLOGY
PATHOLOGY
PATHOLOGY
HEMATOLOGY
(PATHOLOGY)
HEMATOLOGY
(PATHOLOGY)
CYTOPATHOLOGY
CYTOPATHOLOGY
Page 227 of 301
Disciplinary
Status Date
FRISCO
WORCESTER
BLOOD
BANKING/TRANSFUSI
ON MEDICINE
HEMATOLOGY
(PATHOLOGY)
HEMATOLOGY
(PATHOLOGY)
Registration
Status Date
Disciplinary
Status of
Texas
License
SHREVEPORT LA
ACTIVE
LICENSE
ISSUED
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
ADEFEYISAN, SAMUEL ADEKUNLE,
PEDIATRIC ANES
PEDIATRIC CRITICAL
N7196
MD
8/2/2010
8/2/2015 (PEDS)
CARE MEDICINE
PEDIATRIC ANES
N6236
COX, LYNDSEY ALISON, MD
6/4/2010
6/4/2015 (PEDS)
ANESTHESIOLOGY
PEDIATRIC ANES
N5511
HENRY, DESMOND BRYAN JR, MD
2/5/2010
2/5/2015 (PEDS)
PEDIATRICS
PEDIATRIC ANES
N7458
MAPOSA, DOUGLAS , MD
8/16/2010
8/16/2015 (PEDS)
PEDIATRIC ANES
N3866
MARINO, MICHELLE , MD
8/21/2009
8/21/2014 (PEDS)
ANESTHESIOLOGY
PEDIATRIC
HERNANDEZ, JENNIFER LORETTE,
ANESTHESIOLOGY
P7280
MD
7/15/2013
7/15/2018 (PEDS)
ANESTHESIOLOGY
PEDIATRIC
ANESTHESIOLOGY
N9089
LEE, SHARON, MD
3/15/2011
3/15/2016 (PEDS)
PEDIATRIC
BAIRD, CHRISTOPHER WALLACE,
CARDIOTHORACIC
N4273
MD
11/6/2009
11/6/2014 SURGERY
THORACIC SURGERY
PEDIATRIC
CARDIOTHORACIC
CARDIOVASCULAR
N9224
HINES, MICHAEL HERBERT, MD
4/1/2011
4/1/2016 SURGERY
SURGERY
PEDIATRIC
NURI, MUHAMMAD ATAUNUR
CARDIOTHORACIC
CARDIOVASCULAR
P6230
KHALID, MD
4/12/2013
4/12/2018 SURGERY
SURGERY
PEDIATRIC
CARDIOTHORACIC
N7576
RANNE, RICHARD DOUGLAS, MD
8/27/2010
8/27/2015 SURGERY
PEDIATRIC SURGERY
PEDIATRIC
CARDIOTHORACIC
N4811
TUREK, JOSEPH WILLIAM, MD
11/6/2009
11/6/2014 SURGERY
PEDIATRIC CRITICAL
P0895
BRONICKI, RONALD ALAN, MD
9/1/2011
9/1/2016 CARE MEDICINE
PEDIATRIC CRITICAL
L0910
BURNS, TANIA DENISE, MD
11/15/2011 11/15/2016 CARE MEDICINE
PEDIATRICS
PEDIATRIC CRITICAL
P1451
D'COSTA, QUEENIE MOUSUMI, MD 11/15/2011 11/15/2016 CARE MEDICINE
PEDIATRIC CRITICAL
N1317
FANNING, JEFFREY JOHN, MD
10/10/2008 10/10/2013 CARE MEDICINE
PEDIATRIC CRITICAL
N6328
GREEN, MICHAEL LINDEN, MD
6/4/2010
Page 228 of 301
Practice City
COLUMBIA
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/23/2010 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
TX
ACTIVE
8/24/2010 None
N/A
SAN ANTONIO TX
ACTIVE
9/14/2009 None
N/A
DALLAS
TX
ACTIVE
7/23/2013 None
N/A
SAN ANTONIO TX
ACTIVE
4/18/2011 None
N/A
DALLAS
TX
ACTIVE
11/24/2009 None
N/A
HOUSTON
TX
ACTIVE
4/6/2011 None
N/A
ACTIVE
4/15/2013 None
N/A
HOUSTON
MO
Registration
Status Date
Disciplinary
Status of
Texas
License
LUBBOCK
TX
ACTIVE
9/3/2010 None
N/A
DURHAM
NC
ACTIVE
11/16/2009 None
N/A
HOUSTON
TX
ACTIVE
9/8/2011 None
N/A
EL PASO
TX
ACTIVE
12/6/2011 None
N/A
TEMPLE
TX
ACTIVE
11/23/2011 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
10/15/2008 None
N/A
6/4/2010 None
N/A
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC CRITICAL
P5283
KRAMER, BREE CYRENE, DO
1/15/2013
PEDIATRIC CRITICAL
P3030
LIEPPMAN, KYLE, MD
5/1/2012
PEDIATRICS
MEYER, ANDREW DUNCAN
PEDIATRIC CRITICAL
P0855
JOSEPH, MD
8/26/2011
PEDIATRICS
PEDIATRIC CRITICAL
N3909
MORRIS, SUSAN HENDERSON , MD
8/21/2009
PEDIATRIC CRITICAL
N4032
RELVAS, MONICA DE STEFANI, MD
8/21/2009
PEDIATRIC CRITICAL
N5384
SCHOOLER, KEVIN PATRICK, MD
2/5/2010
PEDIATRICS
PEDIATRIC CRITICAL
P6915
SHARMA, KAMAL PRASAD, MD
6/3/2013
N7590
THAPAR, VANDANA C, MD
8/27/2010
N4853
WU, THEODORE, MD
11/6/2009
N6113
YARROZU, ABEL RAJESH, MD
4/9/2010
N7194
ZULUAGA, MARIA TERESA, MD
7/15/2010
P1048
BECKER, EMILY MARIE, MD
10/3/2011
P0904
HILL, SAMANTHA E, MD
N0774
N5553
GALES, MARIA SUZANNE, MD
BANDYOPADHYAY, SUBHANKAR ,
MD
N2009
BOLAND, PAMELA GRAY, MD
N3643
FLYNN, ROCHELLE ROXANNE, MD
8/21/2009
N6426
KLECZEWSKI, HEATHER ANN, MD
6/4/2010
N3824
LEFORT, ROXANNA, MD
N8681
LUGO, MANUEL, MD
9/1/2011
8/29/2008
4/9/2010
2/6/2009
8/21/2009
2/4/2011
PEDIATRIC CRITICAL
PEDIATRICS
PEDIATRIC CRITICAL
PEDIATRICS
PEDIATRIC CRITICAL
PEDIATRICS
PEDIATRIC CRITICAL
PEDIATRIC
PEDIATRIC
DERMATOLOGY
PEDIATRIC EMER MED
8/29/2013 (EM)
PEDIATRICS
PEDIATRIC EMER MED
4/9/2015 (PEDS)
PEDIATRIC EMER MED
2/6/2014 (PEDS)
PEDIATRICS
PEDIATRIC EMER MED
8/21/2014 (PEDS)
PEDIATRICS
PEDIATRIC EMER MED
6/4/2015 (PEDS)
PEDIATRIC EMER MED
8/21/2014 (PEDS)
PEDIATRIC EMER MED
2/4/2016 (PEDS)
PEDIATRICS
Page 229 of 301
Practice City
EL PASO
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
ACTIVE
1/25/2013 None
N/A
ACTIVE
5/3/2012 None
N/A
SAN ANTONIO TX
ACTIVE
9/7/2011 None
N/A
DALLAS
TX
ACTIVE
9/1/2009 None
N/A
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
8/27/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
6/7/2013 None
SEE
PREVIOUS
9/14/2010 ORDER
HOUSTON
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
SAN ANTONIO TX
ACTIVE
SAN ANTONIO TX
N/A
8/27/2010
1/7/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/15/2010 None
N/A
7/15/2010 None
N/A
SAN ANTONIO TX
ACTIVE
10/9/2011 None
N/A
AUSTIN
TX
ACTIVE
9/6/2011 None
N/A
SAN ANTONIO TX
ACTIVE
10/31/2008 None
N/A
ACTIVE
4/22/2010 None
N/A
TX
ACTIVE
3/18/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/26/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/28/2009 None
N/A
2/4/2011 None
N/A
WEBSTER
CORPUS
CHRISTI
HOUSTON
TX
License
Number
Physician Name
N2679
MURILLO, TOMAS ALBERTO , MD
N6975
RODRIGUEZ, DAVID MICHAEL, MD
N8142
N8869
SANDERS, BRIAN, MD
VAZQUEZ-CUFFE, ERIKA MARIE,
MD
P0455
NGUYEN, VU ANH, MD
N3485
BASSHAM, BRIAN SCOTT, MD
P6362
CONTRERAS, JAMIE JAQUA, MD
N9443
COOPER, MICHAEL CRONIN, MD
N9697
DUBOIS, DALE DAVID, MD
P0211
FLOYED, REBECCA LYNN, MD
P3012
KAMAT, SHYAMA, MD
P0420
KAZI, BEENA , MD
P0844
LANSKI, STEVEN L, MD
M3011
MARR, JONATHAN K, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC EMER MED
4/3/2009
4/3/2014 (PEDS)
PEDIATRICS
PEDIATRIC EMER MED
7/1/2010
7/1/2015 (PEDS)
PEDIATRICS
PEDIATRIC EMER MED
11/15/2010 11/15/2015 (PEDS)
PEDIATRIC EMER MED
2/15/2011
2/15/2016 (PEDS)
PEDIATRIC
EMERGENCY
7/15/2011
7/15/2016 MEDICINE (EM)
PEDIATRIC
EMERGENCY
5/1/2013
5/1/2018 MEDICINE (PEDS)
PEDIATRIC
EMERGENCY
5/1/2013
PEDIATRIC
EMERGENCY
4/15/2011
PEDIATRIC
EMERGENCY
5/16/2011
PEDIATRIC
EMERGENCY
7/1/2011
PEDIATRIC
EMERGENCY
5/1/2012
PEDIATRIC
EMERGENCY
7/15/2011
PEDIATRIC
EMERGENCY
8/26/2011
PEDIATRIC
EMERGENCY
5/1/2013
Practice City
Registration
Status of
Practice
Texas
State
License
FORT WORTH TX
ACTIVE
DALLAS
TX
PEDIATRICS
PEDIATRICS
4/8/2009 None
N/A
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
7/22/2010 None
N/A
2/13/2011 None
N/A
2/15/2011 None
N/A
TX
ACTIVE
7/21/2011 None
N/A
HOUSTON
TX
ACTIVE
5/24/2013 None
N/A
PLANO
TX
ACTIVE
5/6/2013 None
N/A
LICENSE
ISSUED
4/15/2011 None
N/A
SAN ANTONIO TX
ACTIVE
5/24/2011 None
N/A
AUSTIN
TX
ACTIVE
7/11/2011 None
N/A
HOUSTON
TX
ACTIVE
5/9/2012 None
N/A
ACTIVE
7/22/2011 None
N/A
TX
ACTIVE
9/6/2011 None
N/A
FORT WORTH TX
ACTIVE
5/9/2013 None
N/A
PEDIATRICS
Page 230 of 301
Disciplinary
Status Date
SUGAR LAND
PEDIATRICS
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
EL PASO
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
PEDIATRIC
MORO-SUTHERLAND, DONNA
EMERGENCY
J9225
MARIE, MD
8/1/2011
PEDIATRIC
EMERGENCY
P6223
NAIR, SAJAY, MD
4/12/2013
PEDIATRIC
EMERGENCY
P6899
RENCHER, LOGAN , DO
6/3/2013
PEDIATRIC
SANDERS, VIRGINIA MARGARET,
EMERGENCY
N9292
MD
4/1/2011
PEDIATRIC
EMERGENCY
P6263
SCHWARTZ, JOANNA DENISE, MD
4/12/2013
PEDIATRIC
EMERGENCY
P5738
STREET, MEGAN HICKMAN, MD
3/1/2013
PEDIATRIC
EMERGENCY
P6740
ULLMAN, NACHMAN , DO
5/15/2013
PEDIATRIC
EMERGENCY
P6938
WYRICK, SARA, MD
6/3/2013
PEDIATRIC
N7403
BURTON, AMY MATHEW, MD
8/16/2010
8/16/2015 ENDOCRINOLOGY
PEDIATRIC
P1174
CORDERO, BRUNILDA, MD
10/17/2011 10/17/2016 ENDOCRINOLOGY
PEDIATRIC
N6244
DANISH, ROBERT K, MD
6/4/2010
PEDIATRIC
N9547
FLORES, MAURICIO ERNESTO, MD
5/2/2011
GOMEZ-MEADE, CARLEY ANNE,
PEDIATRIC
P0725
DO
8/15/2011
PEDIATRIC
P7640
GRANADOS, HECTOR MANUEL, MD
8/15/2013
PEDIATRIC
N9866
GROVER, MONICA , MD
6/3/2011
PEDIATRIC
N5106
HICKS, KELLY ANNE, MD
2/5/2010
Secondary Specialty
(Self-Designated)
PEDIATRICS
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
PEDIATRICS
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/8/2011 None
N/A
LICENSE
ISSUED
4/12/2013 None
N/A
LICENSE
ISSUED
6/3/2013 None
N/A
PEDIATRICS
SAN ANTONIO TX
ACTIVE
4/28/2011 None
N/A
PEDIATRICS
AUSTIN
ACTIVE
4/25/2013 None
N/A
3/1/2013 None
N/A
TX
LICENSE
ISSUED
PEDIATRIC CRITICAL
CARE MEDICINE
CLEVELAND
OH
ACTIVE
7/16/2013 None
N/A
PEDIATRICS
AUSTIN
TX
ACTIVE
6/10/2013 None
N/A
PEDIATRICS
DALLAS
TX
ACTIVE
8/24/2010 None
N/A
PEDIATRICS
FAYETTEVILLE NC
ACTIVE
LICENSE
ISSUED
11/3/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
5/9/2011 None
N/A
PEDIATRICS
PEDIATRICS
PEDIATRICS
Page 231 of 301
MIAMI
FL
ACTIVE
8/22/2011 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/20/2013 None
N/A
6/3/2011 None
N/A
2/5/2010 None
N/A
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
PEDIATRIC
N9878
IDRIS, MOHAMED HUSSEIN, MD
6/3/2011
PEDIATRIC
N6901
KIM, ROY JUNG WOO, MD
7/1/2010
PEDIATRIC
N8022
KIM, TONI, MD
10/29/2010 10/29/2015 ENDOCRINOLOGY
PEDIATRIC
N1737
LIN, YUEZHEN , MD
12/12/2008 12/12/2013 ENDOCRINOLOGY
PEDIATRIC
P6213
LUNSFORD, ALISON JOAN, MD
4/12/2013
PEDIATRIC
P5110
MOKHASHI, MOINUDDIN HABIB, MD 12/17/2012 12/17/2017 ENDOCRINOLOGY
PEDIATRIC
P5110
PEDIATRIC
P5110
PEDIATRIC
N5299
ORSI, CARISSE MENDOZA, MD
2/5/2010
RAO, KRISHNASWAMY JYOTSNA,
PEDIATRIC
P7840
MD
8/30/2013
PEDIATRIC
N7588
STRAIGHT, ANN MARIE, MD
8/27/2010
PEDIATRIC FORENSIC
N6525
NARANG, SANDEEP K, MD
6/4/2010
6/4/2015 MEDICINE
PEDIATRIC
GASTROENTEROLOG
N7898
ABDELHADI, RUBA, MD
10/15/2010 10/15/2015 Y
PEDIATRIC
ALKALAY, MICHELE JACQUELINE,
GASTROENTEROLOG
P0950
MD
9/15/2011
9/15/2016 Y
PEDIATRIC
GASTROENTEROLOG
N8758
BARAD, ASHIS VANMALI, MD
2/15/2011
2/15/2016 Y
PEDIATRIC
GASTROENTEROLOG
N7789
DEBROY, ASHISH NARAYAN, MD
10/1/2010
10/1/2015 Y
PEDIATRIC
GASTROENTEROLOG
P4435
DESAI, SONAL SUBODH, MD
9/17/2012
9/17/2017 Y
Secondary Specialty
(Self-Designated)
PEDIATRIC
ENDOCRINOLOGY
Practice City
INTERNAL MEDICINE
PEDIATRICS
HOUSTON
TX
ACTIVE
AMARILLO
TX
ACTIVE
LICENSE
ISSUED
CORPUS
CHRISTI
CORPUS
CHRISTI
PEDIATRICS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
EL PASO
6/3/2011 None
N/A
7/1/2010 None
N/A
10/29/2010 None
N/A
12/29/2008 None
N/A
4/29/2013 None
N/A
12/17/2012 None
N/A
ACTIVE
2/6/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
2/6/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/4/2013 None
N/A
8/27/2010 None
N/A
6/4/2010 None
N/A
TX
PEDIATRICS
Page 232 of 301
Disciplinary
Status Date
TX
PEDIATRICS
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANTONIO TX
ACTIVE
10/27/2010 None
N/A
MOUNT KISCO NY
ACTIVE
9/26/2011 None
N/A
LICENSE
ISSUED
2/15/2011 None
N/A
TX
ACTIVE
10/8/2010 None
N/A
SAN ANTONIO TX
ACTIVE
9/25/2012 None
N/A
HOUSTON
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
PEDIATRIC
GASTROENTEROLOG
P1989
ECHARTEA GONZALEZ, JAIME, MD
2/1/2012
2/1/2017 Y
PEDIATRIC
GASTROENTEROLOG
N5708
HARPAVAT, SANJIV , MD
4/9/2010
4/9/2015 Y
PEDIATRIC
GASTROENTEROLOG
N7631
KOOROS, KOOROSH, MD
9/1/2010
9/1/2015 Y
PEDIATRIC
GASTROENTEROLOG
P6227
NG, KENNETH , DO
4/12/2013
4/12/2018 Y
PEDIATRIC
GASTROENTEROLOG
N6557
PANDRANGI, BHARANI, MD
6/4/2010
6/4/2015 Y
PEDIATRIC
GASTROENTEROLOG
P5298
PATEL, HENNA, DO
1/15/2013
1/15/2018 Y
PEDIATRIC
ROJAS SANTAMARIA, ISABEL
GASTROENTEROLOG
N9945
CRISTINA, MD
6/3/2011
6/3/2016 Y
PEDIATRIC
HEMATOLOGY/ONCOL
N9167
ASSANASEN, CHATCHAWIN , MD
4/1/2011
4/1/2016 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
N1988
BAKER, ASHLEY ANN, MD
2/6/2009
2/6/2014 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
N5585
BRACKETT, JULIENNE , MD
4/9/2010
4/9/2015 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
P0206
ESQUILIN, JOSE MANUEL, MD
7/1/2011
7/1/2016 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
P0591
GEORGE, ALEX, MD
8/1/2011
8/1/2016 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
N4436
GOZMAN, ALEXANDER, MD
11/6/2009
11/6/2014 OGY
Secondary Specialty
(Self-Designated)
PEDIATRICS
Practice City
CINCINNATI
Registration
Status of
Practice
Texas
State
License
OH
PEDIATRICS
PEDIATRICS
DALLAS
TX
PEDIATRICS
PEDIATRICS
ARLINGTON
TX
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
2/3/2012 None
N/A
LICENSE
ISSUED
4/9/2010 None
N/A
ACTIVE
9/27/2010 None
N/A
LICENSE
ISSUED
4/12/2013 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
1/23/2013 None
N/A
LICENSE
ISSUED
6/3/2011 None
N/A
ACTIVE
PEDIATRICS
SAN ANTONIO TX
ACTIVE
4/7/2011 None
N/A
PEDIATRICS
HOUSTON
TX
ACTIVE
3/11/2009 None
N/A
HOUSTON
TX
ACTIVE
4/20/2010 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
7/11/2011 None
N/A
HOUSTON
TX
ACTIVE
8/17/2011 None
N/A
DALLAS
TX
ACTIVE
11/11/2009 None
N/A
Page 233 of 301
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
PEDIATRIC
HEMATOLOGY/ONCOL
N7808
HECZEY, ANDRAS, MD
10/1/2010
10/1/2015 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
L5790
KHATUA, SOUMEN, MD
1/18/2011
1/18/2016 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
N2613
LABORDE, CARRIE ELIZABETH, MD
4/3/2009
4/3/2014 OGY
PEDIATRIC
LAETSCH, THEODORE WILLIS JR,
HEMATOLOGY/ONCOL
P6853
MD
6/3/2013
6/3/2018 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
P6018
LIN, FRANK Y, MD
4/1/2013
4/1/2018 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
N8213
LONGEE, DARRYL CHARLES, MD
12/1/2010
12/1/2015 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
P1667
MAGEE, JEFFREY A, MD
12/15/2011 12/15/2016 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
P7165
NAIK, SWATI , MD
7/1/2013
7/1/2018 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
P7522
NICHOLLS, LAUREN ANNE, MD
8/1/2013
8/1/2018 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
P5711
QUIGG, TROY CHRISTOPHER, DO
3/1/2013
3/1/2018 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
N9940
RAMIREZ, LORIMAR , MD
6/3/2011
6/3/2016 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
P4502
RAU, RACHEL ELIZABETH, MD
9/17/2012
9/17/2017 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
N7747
SASA, GHADIR SULEIMAN, MD
9/15/2010
9/15/2015 OGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
HOUSTON
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HOUSTON
TX
ACTIVE
10/25/2010 None
N/A
TX
ACTIVE
2/3/2011 None
N/A
PEDIATRICS
DALLAS
TX
ACTIVE
4/8/2009 None
N/A
DALLAS
TX
ACTIVE
6/4/2013 None
N/A
HOUSTON
TX
ACTIVE
4/5/2013 None
N/A
ACTIVE
12/21/2010 None
N/A
PEDIATRICS
PEDIATRICS
DALLAS
TX
ACTIVE
12/22/2011 None
N/A
HOUSTON
TX
ACTIVE
7/25/2013 None
N/A
HOUSTON
TX
ACTIVE
8/23/2013 None
N/A
PEDIATRICS
SAN ANTONIO TX
ACTIVE
3/11/2013 None
N/A
PEDIATRICS
HOUSTON
TX
ACTIVE
6/14/2011 None
N/A
HOUSTON
TX
ACTIVE
9/24/2012 None
N/A
HOUSTON
TX
ACTIVE
10/4/2010 None
N/A
Page 234 of 301
License
Number
Physician Name
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
HEMATOLOGY/ONCOL
4/15/2011
4/15/2016 OGY
PEDIATRICS
PEDIATRIC
HEMATOLOGY/ONCOL
10/3/2011
10/3/2016 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
5/15/2013
5/15/2018 OGY
PEDIATRICS
PEDIATRIC
HEMATOLOGY/ONCOL
5/15/2013
5/15/2018 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
9/17/2012
9/17/2017 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
5/29/2009
5/29/2014 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
4/2/2012
4/2/2017 OGY
PEDIATRIC
HEMATOLOGY/ONCOL
6/3/2011
6/3/2016 OGY
PEDIATRICS
PEDIATRIC
HEMATOLOGY/ONCOL
10/10/2008 10/10/2013 OGY
N9487
SIMKO, STEPHEN JAMES III, MD
P1142
SKAPEK, STEPHEN XAVIER, MD
P6727
STEVENS, ALEXANDRA MCLEAN,
MD
P6731
SUNKERSETT, GAURI
BHUPENDRA, DO
P4520
TEWARI, PRITI, MD
N3365
VALLANCE, KELLY LOREN , MD
P2808
WARE, RUSSELL EARL, MD
N9982
WATT, TANYA CARENS, MD
N1495
WOLFF, JOHANNES ERNST
ALEXANDER, MD
N4233
ADERINBOYE, OMOLARA VIOLET,
MD
11/6/2009
N7407
CHING, NATASCHA, MD
P1070
N4551
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
LICENSE
ISSUED
DALLAS
TX
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/15/2011 None
N/A
ACTIVE
10/11/2011 None
N/A
TX
ACTIVE
6/4/2013 None
N/A
DALLAS
TX
ACTIVE
5/16/2013 None
N/A
HOUSTON
TX
ACTIVE
9/19/2012 None
N/A
FORT WORTH TX
ACTIVE
6/4/2009 None
N/A
HOUSTON
TX
ACTIVE
4/12/2012 None
N/A
DALLAS
TX
ACTIVE
6/14/2011 None
N/A
HOUSTON
TX
ACTIVE
10/22/2008 None
N/A
PEDIATRIC
11/6/2014 INFECTIOUS DISEASE HOSPITALIST
LAREDO
TX
ACTIVE
11/11/2009 None
N/A
8/16/2010
PEDIATRIC
8/16/2015 INFECTIOUS DISEASE PEDIATRICS
AUSTIN
TX
ACTIVE
9/6/2010 None
N/A
EVANS, AMANDA SUAREZ, MD
10/3/2011
PEDIATRIC
DALLAS
TX
ACTIVE
11/15/2011 None
N/A
LEVENT, FATMA , MD
11/6/2009
PEDIATRIC
LUBBOCK
TX
ACTIVE
12/7/2009 None
N/A
Page 235 of 301
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P4486
MONGKOLRATTANOTHAI,
KANOKPORN, MD
9/17/2012
P3111
ALI, WAIL, MD
5/15/2012
N6822
BORGMAN, MATTHEW A, MD
7/1/2010
P6969
GAZZANEO, MARIA CAROLINA, MD
N7651
PETRESCU, MATEI STEFAN, MD
N8840
RIVERA, NICOLAS BRAVO JR, MD
2/15/2011
N8164
ANGELO, JOSEPH ROBERT II, MD
12/1/2010
P5932
BEDRI, BADRELDIN, MD
4/1/2013
P1971
BROWN, ELIZABETH J, MD
2/1/2012
P6386
FIRZLI, ELIE SALIM, MD
5/1/2013
P6084
4/1/2013
N6732
SIDDIQUE, KHURRUM , MD
TWOMBLEY, KATHERINE
ELIZABETH, MD
N2358
AGADI, SATISH , MD
4/3/2009
N5549
BALMAKUND, TONYA MICHELE, MD
4/9/2010
P3293
BURRIS, GARRETT C, MD
6/1/2012
N5014
2/5/2010
P6607
DESENA, ALLEN DOUGLAS, MD
DOWDELL-SMITH, CICELY
PATRICE, MD
P0640
MIRELES, PATRICIA SALAZAR, MD
8/1/2011
P0258
MUKALEL, NINON JAMES, MD
7/1/2011
P1478
NALLU, SAGARIKA, MD
6/14/2013
9/1/2010
6/4/2010
5/15/2013
11/15/2011
Secondary Specialty
(Self-Designated)
PEDIATRIC
PEDIATRIC INTENSIVE
5/15/2017 CARE
PEDIATRICS
PEDIATRIC INTENSIVE
7/1/2015 CARE
PEDIATRIC INTENSIVE
6/14/2018 CARE
PEDIATRIC INTENSIVE
9/1/2015 CARE
PEDIATRICS
PEDIATRIC INTENSIVE
2/15/2016 CARE
PEDIATRICS
PEDIATRIC
PEDIATRICS
PEDIATRIC
4/1/2018 NEPHROLOGY
PEDIATRIC
2/1/2017 NEPHROLOGY
PEDIATRIC
5/1/2018 NEPHROLOGY
PEDIATRIC
4/1/2018 NEPHROLOGY
PEDIATRICS
PEDIATRIC
6/4/2015 NEPHROLOGY
PEDIATRICS
PEDIATRIC
4/3/2014 NEUROLOGY
PEDIATRICS
PEDIATRIC
4/9/2015 NEUROLOGY
PEDIATRIC
6/1/2017 NEUROLOGY
PEDIATRICS
PEDIATRIC
2/5/2015 NEUROLOGY
PEDIATRICS
PEDIATRIC
5/15/2018 NEUROLOGY
PEDIATRIC
8/1/2016 NEUROLOGY
PEDIATRIC
7/1/2016 NEUROLOGY
SLEEP MEDICINE
PEDIATRIC
11/15/2016 NEUROLOGY
SLEEP MEDICINE
Page 236 of 301
Practice City
LUBBOCK
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
10/9/2012 None
N/A
5/15/2012 None
N/A
FT. SAM
HOUSTON
TX
ACTIVE
7/27/2010 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/20/2013 None
N/A
9/1/2010 None
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
12/7/2010 None
N/A
4/1/2013 None
N/A
ACTIVE
2/7/2012 None
N/A
ACTIVE
5/13/2013 None
N/A
ACTIVE
LICENSE
ISSUED
4/5/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/8/2009 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/15/2012 None
N/A
2/5/2010 None
N/A
HOUSTON
DALLAS
DALLAS
HOUSTON
HOUSTON
TX
TX
TX
TX
TX
HOUSTON
TX
ACTIVE
5/17/2013 None
N/A
PLANO
TX
ACTIVE
8/5/2011 None
N/A
HOUSTON
TX
ACTIVE
7/7/2011 None
N/A
ACTIVE
12/6/2011 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
PEDIATRIC
5/15/2012
5/15/2017 NEUROLOGY
P3214
ONG, JINFON , MD
P3058
PERKINS, FREEDOM FREDERICK
JR, MD
5/1/2012
N5988
SAID, RANA RIYAD, MD
4/9/2010
N7058
BHATT, AMIT RAKESH, MD
N9332
WOODWARD, LEE M, MD
N0890
KIM, HARRY KWANG-WOO, MD
8/29/2008
P1565
MANSOUR, ALFRED AMEEN III, MD
12/1/2011
P0634
MAY, MEGAN MICHELLE, MD
8/1/2011
N9917
MURDOCK, RYAN C, MD
6/3/2011
N8350
STALL, ALEC CHRISTIAN, MD
N7756
7/15/2010
4/1/2011
12/15/2010
P5009
THOMPSON, J DAVID , MD
UMBERHANDT, ROBERT CECIL,
MD
9/15/2010
P0259
MUSSO, MARYFRANCES , DO
7/1/2011
P5458
ROEHM, CORRIE ELIZABETH, MD
2/1/2013
N6682
STAVINOHA, ROSE CAITLIN, MD
6/4/2010
H9368
LUQUETTE, MARK HENRY, MD
11/30/2012
11/6/2009
M5035
ATKINSON, DAVID LOUIS, MD
6/3/2011
P0960
BROOKS, DAVID BRADLEY, MD
9/15/2011
P1365
MOORE, NAKITA M, MD
11/4/2011
PEDIATRIC
5/1/2017 NEUROLOGY
PEDIATRIC
4/9/2015 NEUROLOGY
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
PEDIATRIC
11/6/2014 PATHOLOGY
PEDIATRIC
6/3/2016 PSYCHIATRY
PEDIATRIC
PEDIATRIC
Secondary Specialty
(Self-Designated)
Practice City
SPORTS MEDICINE
(ORTH SURG)
Disciplinary
Status Date
5/18/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/18/2012 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/21/2010 None
N/A
4/1/2011 None
N/A
DALLAS
TX
GREEENWOO
D VILLAGE
CO
ACTIVE
10/9/2008 None
N/A
ACTIVE
12/6/2011 None
N/A
HOUSTON
TX
ACTIVE
8/12/2011 None
N/A
PHILADELPHIA PA
ACTIVE
6/10/2011 None
N/A
DALLAS
ACTIVE
12/28/2010 None
N/A
ACTIVE
9/22/2010 None
N/A
TX
ACTIVE
12/3/2012 None
N/A
TX
ACTIVE
7/6/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
2/11/2013 None
N/A
6/4/2010 None
N/A
11/6/2009 None
N/A
HOUSTON
TX
TX
TX
ORTHOPEDIC
SURGERY
ORTHOPEDICS
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
CLINICAL
NEUROPHYSIOLOGY AUSTIN
OPHTHALMOLOGY
Registration
Status of
Practice
Texas
State
License
DALLAS
OTORHINOLARYNGO
LOGY
HOUSTON
GALVESTON
TX
ADDICTION
PSYCHIATRY
FORT WORTH TX
ACTIVE
6/13/2011 None
N/A
PSYCHIATRY
EL PASO
TX
ACTIVE
9/21/2011 None
N/A
PSYCHIATRY
TEMPLE
TX
ACTIVE
11/29/2011 None
N/A
Page 237 of 301
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
PEDIATRIC
P5180
STUBBS, JENEE' GIBSON, MD
1/4/2013
1/4/2018 PSYCHIATRY
PEDIATRIC
P3606
ANSARI, ASAD, MD
6/15/2012
6/15/2017 PULMONOLOGY
PEDIATRIC
N5617
CHAVEZ, ALMA ISELA, MD
4/9/2010
PEDIATRIC
P1634
DAFTARY, AMEET SHIRISH, MD
12/15/2011 12/15/2016 PULMONOLOGY
PEDIATRIC
N5754
KANCHERLA, BINAL SHAH, MD
4/9/2010
PEDIATRIC
N6997
SHARMA, PREETI BHATIA, MD
7/1/2010
SOBANDE, PATRICK OLAMIDOTUN,
PEDIATRIC
P0500
MD
7/15/2011
PEDIATRIC
L6654
STARK, JAMES MATTHEW, MD
8/1/2011
PEDIATRIC
N8868
VAYSMAN, DMITRIY , MD
2/15/2011
PEDIATRIC
P3478
VILLA, FILOMENA HAZEL , MD
6/1/2012
PEDIATRIC
REHABILITATION
N3625
DY, ROCHELLE COLEEN TAN , MD
8/21/2009
8/21/2014 MEDICINE
PEDIATRIC
REHABILITATION
N9562
HACKER, CALLENDA A, MD
5/2/2011
5/2/2016 MEDICINE
GIRONELLA, ANNA CARMELA
PEDIATRIC
P4652
SAGCAL, MD
10/15/2012 10/15/2017 RHEUMATOLOGY
PEDIATRIC
P6403
GUIROLA, RICARDO , MD
5/1/2013
5/1/2018 RHEUMATOLOGY
PEDIATRIC
N1700
KAMDAR, ANKUR ASHWIN, MD
12/12/2008 12/12/2013 RHEUMATOLOGY
PEDIATRIC
P1791
MOSER, DAVID WALTER, DO
1/2/2012
PEDIATRIC
P5562
RAMIREZ, ANDREA ANNE, MD
2/8/2013
PEDIATRIC
N9486
SHULMAN, ANDREW IRA, MD
4/15/2011
PEDIATRIC
N7364
UMER, SARWAT, MD
8/2/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
PSYCHIATRY
SLEEP MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
1/11/2013 None
N/A
6/15/2012 None
N/A
ACTIVE
4/26/2010 None
N/A
SLEEP MEDICINE
SALT LAKE
CITY
UT
ACTIVE
12/29/2011 None
N/A
SLEEP MEDICINE
HOUSTON
TX
ACTIVE
4/16/2010 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
7/16/2010 None
N/A
7/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/5/2011 None
N/A
2/15/2011 None
N/A
PEDIATRICS
HOUSTON
TX
SLEEP MEDICINE
PEDIATRICS
SPORTS MEDICINEPEDS
RHEUMATOLOGY
Page 238 of 301
SAN ANTONIO TX
ACTIVE
6/8/2012 None
N/A
HOUSTON
TX
ACTIVE
8/25/2009 None
N/A
DALLAS
TX
ACTIVE
6/16/2011 None
N/A
HOUSTON
TX
ACTIVE
10/18/2012 None
N/A
HOUSTON
TX
ACTIVE
5/3/2013 None
N/A
HOUSTON
TX
ACTIVE
12/22/2008 None
N/A
AUSTIN
TX
ACTIVE
1/4/2012 None
N/A
HOUSTON
TX
ACTIVE
2/21/2013 None
N/A
DALLAS
TX
ACTIVE
4/21/2011 None
N/A
DALLAS
TX
ACTIVE
9/20/2010 None
N/A
License
Number
N1230
Physician Name
edicaid
edicaid
End Date
Designated)
PEDIATRIC
8/29/2008
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
P5970
WRIGHT, TRACEY , MD
DURRANT, AUDREY CARMELITA,
MD
P7273
FITZGERALD, TAMARA N, MD
7/15/2013
7/15/2018 PEDIATRIC SURGERY GENERAL SURGERY EL PASO
TX
ACTIVE
8/21/2013 None
N/A
N3036
N5695
FUCHS, JULIE ROBIN , MD
GRETHEL, ERICH JOSEPH, MD
5/29/2009
4/9/2010
5/29/2014 PEDIATRIC SURGERY GENERAL SURGERY DALLAS
4/9/2015 PEDIATRIC SURGERY
AUSTIN
TX
TX
ACTIVE
ACTIVE
6/3/2009 None
4/26/2010 None
N/A
N/A
N3067
HAMNER, CHAD EDWARD , MD
5/29/2009
5/29/2014 PEDIATRIC SURGERY GENERAL SURGERY FORT WORTH TX
6/18/2009 None
N/A
P0598
HANNA, ANGELA MARIE, MD
8/1/2011
ACTIVE
LICENSE
ISSUED
8/1/2011 None
N/A
P5988
HARTING, MATTHEW TIHEN, MD
4/1/2013
N3094
JACKSON, RICHARD JEFFREY, MD
N7934
KIMMEL, STEPHEN GEORGE, MD
N7560
N9909
8/27/2010
6/3/2011
P3391
MATTIX, KELLY RYMAN, MD
MELLER, JANET LOUISE, MD
MITCHELL, IAN CRICHTON SLIGHT,
MD
N7856
PANAYIDES, KYRIACOS , MD
10/1/2010
10/1/2015 PEDIATRIC SURGERY GENERAL SURGERY
N8836
P1016
PIMPALWAR, ASHWIN , MD
RODRIGUEZ, JOSE RUBEN, MD
2/15/2011
9/15/2011
N9789
5/16/2011
5/16/2016 PEDIATRIC SURGERY GENERAL SURGERY FORT WORTH TX
P0681
UFFMAN, JOHN KENNETH, MD
VASUDEVAN, SANJEEV
AYYANGAR, MD
P2608
4/1/2013
5/29/2009
TX
ACTIVE
9/26/2008 None
N/A
4/1/2018 PEDIATRIC SURGERY GENERAL SURGERY SAN ANTONIO TX
ACTIVE
4/11/2013 None
N/A
8/1/2016 PEDIATRIC SURGERY GENERAL SURGERY
CRITICAL CARE
4/1/2018 PEDIATRIC SURGERY (SURGERY)
HOUSTON
10/15/2010 10/15/2015 PEDIATRIC SURGERY
6/1/2012
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
4/8/2013 None
N/A
FORT WORTH TX
ACTIVE
7/7/2009 None
N/A
PENSACOLA
FL
ACTIVE
10/27/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
9/1/2010 None
6/16/2011 None
N/A
N/A
6/5/2012 None
N/A
10/1/2010 None
N/A
2/15/2011 None
9/19/2011 None
N/A
N/A
ACTIVE
6/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/5/2011 None
N/A
4/2/2012 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/9/2013 None
N/A
9/1/2010 None
N/A
8/27/2015 PEDIATRIC SURGERY GENERAL SURGERY TEMPLE
AMARILLO
6/1/2017 PEDIATRIC SURGERY GENERAL SURGERY SAN ANTONIO TX
HOUSTON
8/1/2011
8/1/2016 PEDIATRIC SURGERY GENERAL SURGERY HOUSTON
CASALE, ANTHONY JOSEPH, MD
4/2/2012
4/2/2017 PEDIATRIC UROLOGY UROLOGY
N5149
KAYE, JONATHAN DAVID, MD
2/5/2010
P7138
KOH, CHESTER, MD
7/1/2013
7/1/2018 PEDIATRIC UROLOGY UROLOGIC SURGERY HOUSTON
N7645
NOVAK, THOMAS EDWARD, MD
9/1/2010
Page 239 of 301
TX
TX
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
N6582
PHILLIPS, TIMOTHY MARTIN, MD
6/4/2010
P4817
SCHLOMER, BRUCE JEREMY, MD
11/1/2012
N8873
WHITE, MICHAEL ANTHONY, DO
2/15/2011
2/15/2016 PEDIATRIC UROLOGY
N4877
ACEVEDO, SARAH AMANDA, MD
ACOSTA, VERONICA DEL
SOCORRO, MD
ADEDIJI, FAUSAT ABIDEMI, MD
ADETONA, OLUTOLA OLUGBENGA,
MD
AFOLABI, FOLASHADE
CATHERINE, MD
P2567
P4404
N1971
P0330
Practice City
6/4/2015 PEDIATRIC UROLOGY UROLOGIC SURGERY
2/5/2010
2/5/2015 PEDIATRICS
4/2/2012
9/17/2012
4/2/2017 PEDIATRICS
2/6/2009
2/6/2014 PEDIATRICS
7/15/2011
P4405
AGARWAL, HEMANT SHYAM, MD
9/17/2012
P1258
AHMADIAN, VERONICA ARCE, MD
11/4/2011
N1518
AHMED, IBRAHIM ABDEL KADER
SAYED, MD
P3108
AIGBIVBALU, LEMUEL OSE, MD
5/15/2012
P6564
N3427
AKALONU, AMAKA , MD
AKIN, LAURA DESPORTE, MD
5/15/2013
8/21/2009
P1613
P1512
AL KHASAWNEH, EIHAB, MD
AL-CHADERCHI, SILVANA Y, MD
N7204
ALLEN-RHOADES, WENDY , MD
8/2/2010
8/2/2015 PEDIATRICS
N8365
ALMOHAMMED, SALAH NASER, MD
1/3/2011
1/3/2016 PEDIATRICS
P6767
ALOOR, SIMMY , MD
6/3/2013
6/3/2018 PEDIATRICS
N7672
ALTAMIRANO, LEO CARDENAS, MD
9/15/2010
12/12/2008 12/12/2013 PEDIATRICS
12/15/2011 12/15/2016 PEDIATRICS
12/1/2011
SAN
FRANCISCO
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Disciplinary
Status Date
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/9/2013 None
N/A
2/15/2011 None
N/A
2/5/2010 None
N/A
TX
OK
ACTIVE
ACTIVE
4/27/2012 None
11/8/2012 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
3/6/2009 None
N/A
DALLAS
TX
ACTIVE
8/5/2011 None
N/A
NASHVILLE
TN
ACTIVE
10/1/2012 None
N/A
SAN ANTONIO TX
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
PEDIATRIC
INFECTIOUS
DISEASE
GALVESTON TX
ACTIVE
11/17/2011 None
N/A
ACTIVE
7/22/2009 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
5/25/2012 None
N/A
5/15/2013 None
9/22/2009 None
N/A
N/A
12/15/2011 None
12/6/2011 None
N/A
N/A
8/24/2010 None
N/A
1/3/2011 None
N/A
6/3/2013 None
N/A
9/15/2010 None
N/A
DALLAS
SHAWNEE
PEDIATRIC EMER
MED (EM)
PEDIATRIC
INTENSIVE CARE
CA
Registration
Status Date
Disciplinary
Status of
Texas
License
PEDIATRICS
SAN ANTONIO TX
PEDIATRIC
NEPHROLOGY
PEDIATRICS
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HOUSTON
Page 240 of 301
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
P7059
Physician Name
edicaid
edicaid
End Date
Designated)
7/1/2013
7/1/2018 PEDIATRICS
N4246
P7242
N9801
ALVA, MARIA DOLORES, MD
AMAYA HELLMAN, DIANA STELLA,
MD
ANOSIKE, BRENDA IJ, MD
ANSARI, MOHSIN, MD
11/6/2009
7/15/2013
6/3/2011
6/3/2016 PEDIATRICS
N6808
ANSLEY, SHARHONDA MARIE, MD
7/1/2010
7/1/2015 PEDIATRICS
N1531
ANUNOBI, ENDALINE AMAKA, MD
ANYAEGBU, ELIZABETH IJEOMA,
MD
ARANA, JULIA GARRETT, MD
P2577
L0751
Secondary Specialty
(Self-Designated)
Practice City
PEDIATRIC CRITICAL
CARE MEDICINE
PENSACOLA
NEONATOLOGY
12/12/2008 12/12/2013 PEDIATRICS
PEDIATRIC
NEPHROLOGY
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
FL
ACTIVE
7/31/2013 None
N/A
TX
TX
MD
ACTIVE
ACTIVE
ACTIVE
11/19/2009 None
7/22/2013 None
6/10/2011 None
N/A
N/A
N/A
ACTIVE
7/13/2010 None
N/A
SAN ANTONIO TX
ACTIVE
12/29/2008 None
N/A
ST LOUIS
COLUMBIA
MO
SC
ACTIVE
ACTIVE
4/9/2012 None
6/20/2011 None
N/A
N/A
HOUSTON
HOUSTON
SALISBURY
4/2/2012
5/2/2011
4/2/2017 PEDIATRICS
5/2/2016 PEDIATRICS
8/21/2009
6/3/2013
6/3/2018 PEDIATRICS
EL PASO
DALLAS
TX
TX
ACTIVE
ACTIVE
9/1/2009 None
6/12/2013 None
N/A
N/A
8/21/2009
6/3/2013
6/3/2018 PEDIATRICS
BEEVILLE
NEW YORK
TX
NY
ACTIVE
ACTIVE
9/7/2009 None
6/24/2013 None
N/A
N/A
6/3/2011
6/3/2016 PEDIATRICS
POMONA
NJ
ACTIVE
6/13/2011 None
N/A
4/13/2012
PHOENIX
AZ
ACTIVE
4/26/2012 None
N/A
8/29/2008
FORT WORTH TX
9/9/2008 None
N/A
4/8/2011
4/8/2016 PEDIATRICS
4/8/2011 None
N/A
8/2/2010
8/2/2015 PEDIATRICS
P7063
AVILA, JAMIE , MD
AYESTARAN CASSANI,
ALEJANDRA CRISTINA, MD
AYOUB-RODRIGUEZ, LISA
MICHELLE, MD
ACTIVE
LICENSE
ISSUED
7/1/2013
7/1/2018 PEDIATRICS
P4732
AZUOGU, ONYEMEZE , MD
11/1/2012
N4271
P2951
N5546
P6332
N9506
BADAWY, MOHAMED KARIM , MD
BAGRODIA, MONA AMBIKA, MD
BAIG, NAZIA , MD
BAIRD, TIFFANY RENEE, MD
BANKS, CRYSTAL LEIGH, MD
11/6/2009
5/1/2012
4/9/2010
5/1/2013
5/2/2011
11/6/2014
5/1/2017
4/9/2015
5/1/2018
5/2/2016
N3454
P6774
N3458
P6775
N9803
P2823
N0616
N9346
N7213
ARISTIZABAL-ORTIZ, ANDRES , MD
ARORA, ALLURY, MD
ARREAZA GRATEROL, MARIA
MARGARITA, MD
ARSLANOV, RENAT, MD
ASIEGBU, BENEDICT EMEKA, MD
ATOLAGBE, ADEBAYO OLUFEMI,
MD
AVALOS MISHAAN, ANA MIRIAM,
MD
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
NEONATOLOGY
HOSPITALIST
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
PEDIATRIC EMER
MED (PEDS)
Page 241 of 301
SAN ANGELO
TX
ACTIVE
8/9/2010 None
N/A
EL PASO
TX
ACTIVE
7/19/2013 None
N/A
EL PASO
TX
ACTIVE
12/4/2012 None
N/A
DALLAS
CEDAR HILL
TX
TX
MANSFIELD
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
11/11/2009
6/28/2012
4/16/2010
5/17/2013
5/6/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N7675
BARIUAN, APRIL JOY GALVEZ, MD
9/15/2010
P6137
BASALDUA, KELLY MARIE, MD
4/12/2013
N4936
BATCHELOR, KRYSTAL RENAE, DO
2/5/2010
2/5/2015 PEDIATRICS
P6584
P0544
5/15/2013
8/1/2011
8/1/2016 PEDIATRICS
N4288
BATISTA, DALIA L, MD
BEAN, GARY ERWIN, MD
BEAUCHAMP, BRANDY LA'SHAY,
MD
11/6/2009
N4941
BEKELE, MEAZA TILAHUN, MD
2/5/2010
2/5/2015 PEDIATRICS
P5336
BENDURE, ERIN O'NEILL, MD
2/1/2013
2/1/2018 PEDIATRICS
N5567
P3288
BERG, BRADLEY ROSS, MD
BETTY, IRMA ELENA, MD
4/9/2010
6/1/2012
4/9/2015 PEDIATRICS
6/1/2017 PEDIATRICS
N9023
N2949
BEYDA, REBECCA MONK, MD
BHATTI, MEENU SINGH , MD
N1555
BILLINGSLEY, TRAVIS ALLEN, MD
P0350
BOOTH, ADA LOUISE, MD
N9173
3/15/2011
5/29/2009
12/12/2008 12/12/2013 PEDIATRICS
7/15/2011
BOWMAN, THOMAS ANDREW, MD
4/1/2011
4/1/2016 PEDIATRICS
P3511
N6827
P3292
P2419
BRENNAN, RACHEL MICHELLE, DO
BROOKS, JACEL CRAIG, MD
BROWN, EMILY RENEE, MD
BRUNO, KATIE ELIZABETH, MD
6/8/2012
7/1/2010
6/1/2012
3/15/2012
N4968
BURGER, CRAIG M, MD
2/5/2010
2/5/2015 PEDIATRICS
P2964
BUSTOS MUNOZ, SERGIO , MD
5/1/2012
5/1/2017 PEDIATRICS
N6204
BUTLER WEBB, REBECCA, MD
6/4/2010
6/4/2015 PEDIATRICS
6/8/2017
7/1/2015
6/1/2017
3/15/2017
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
Secondary Specialty
(Self-Designated)
Practice City
WEBSTER
Registration
Status of
Practice
Texas
State
License
TX
ADOLESCENT
MEDICINE - PD
NEONATOLOGY
9/20/2010 None
N/A
4/12/2013 None
N/A
2/5/2010 None
N/A
5/15/2013 None
8/5/2011 None
N/A
N/A
11/6/2009 None
N/A
2/5/2010 None
N/A
2/7/2013 None
N/A
4/9/2010 None
6/6/2012 None
N/A
N/A
HOUSTON
TX
ROUND ROCK TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
3/15/2011 None
6/8/2009 None
N/A
N/A
GALVESTON
TX
ACTIVE
1/19/2009 None
N/A
TX
ACTIVE
7/20/2011 None
N/A
TX
ACTIVE
5/2/2011 None
N/A
TX
TX
MO
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
EL PASO
TX
PEDIATRIC
CORPUS
FORENSIC MEDICINE CHRISTI
NEONATALPERINATAL
MEDICINE
LUBBOCK
SPORTS MEDICINE
DALLAS
CYPRESS
SAINT LOUIS
HOSPITALIST
PEDIATRIC CRITICAL
CARE MEDICINE
AMARILLO
Page 242 of 301
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
HOSPITALIST
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
LICENSE
ISSUED
6/15/2012
7/19/2010
6/8/2012
3/29/2012
None
None
None
None
N/A
N/A
N/A
N/A
2/5/2010 None
N/A
5/8/2012 None
N/A
6/4/2010 None
N/A
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
N8492
BYBEE, KRISTY RUTHANN, DO
1/18/2011
HOSPITALIST
PEDIATRICS,
N6205
CABRERA, ANTONIO GABRIEL, MD
6/4/2010
6/4/2015 PEDIATRICS
CARDIOLOGY
P2422
CAJITA, CEZAR LAGO, MD
3/15/2012
P5606
P7404
N7063
F6502
N2021
N9823
P2834
N3537
P6953
N5608
CAJITA, ELEONOR IGNACIO, MD
CALLOWAY, TRACIE SHENELLE,
DO
CAMPANINI, EMIR RAFAEL, MD
CAMPBELL, LYNN RENEE, MD
CANNON, DEAN M., MD
3/1/2013
3/1/2018 PEDIATRICS
8/1/2013
7/15/2010
2/6/2009
2/6/2009
8/1/2018
7/15/2015
2/6/2014
2/6/2014
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
6/3/2011
4/13/2012
8/21/2009
6/14/2013
4/9/2010
6/3/2016
4/13/2017
8/21/2014
6/14/2018
4/9/2015
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
P1170
CAPERTON, ROBIN, MD
CARBALLO, JUAN EDUARDO, MD
CARDO-HUNTER, ALICE , DO
CARRERAS, YULY D, MD
CARROLL, TRAVIS ROD, MD
CASTANO DE ZAMACONA,
MARCELA LUCIA, MD
P3612
CASTILLO, MANUEL, MD
6/15/2012
P3518
P3613
CHAMARTHI, PHANI PRABHAKARA
SRINIVASA SASTRY, MD
CHANG, EDWARD, MD
6/8/2012
6/15/2012
6/8/2017 PEDIATRICS
P0562
P1529
CHAR, VANDANA, MD
CHAUDHARY, AISHA LUBNA, MD
8/1/2011
12/1/2011
8/1/2016 PEDIATRICS
P1530
12/1/2011
P2969
N3561
CHAUDRY, KANWAL NISAR, MD
CHELIKANI KOTAGIRI, SUNANDA,
MD
CHEN, KENNETH, MD
CHENG, CHRISTOPHER HAIYUN,
MD
CHITTUM, JENNIFER ELLEN , MD
N6222
CHIU, CARRIE HERMOSA, MD
P1737
N1582
P3300
CHOKSHI, NITI YOGESH, MD
NEONATOLOGY
10/17/2011 10/17/2016 PEDIATRICS
Registration
Status of
Practice
Texas
Practice City
State
License
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
HARLINGEN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
TEXARKANA
TX
ISSUED
SAN ANGELO TX
ACTIVE
AUSTIN
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
MCALLEN
TX
ACTIVE
BRONX
NY
ACTIVE
LUBBOCK
TX
ACTIVE
SAN ANTONIO TX
EL PASO
ANGLETON
TX
TX
1/2/2012
1/2/2017 PEDIATRICS
12/12/2008 12/12/2013 PEDIATRICS
5/1/2012
8/21/2009
5/1/2017 PEDIATRICS
6/4/2010
6/4/2015 PEDIATRICS
6/1/2012
6/1/2017 PEDIATRICS
PEDIATRICS,
ALLERGY &
IMMUNOLOGY
Page 243 of 301
HOUSTON
TX
6/4/2010 None
3/19/2012 None
N/A
N/A
3/1/2013 None
N/A
8/1/2013
7/26/2010
2/11/2009
2/16/2009
None
None
None
None
N/A
N/A
N/A
N/A
6/3/2011
4/16/2012
8/27/2009
6/24/2013
4/15/2010
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
10/20/2011 None
N/A
6/15/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
6/11/2012 None
6/20/2012 None
N/A
N/A
8/1/2011 None
12/9/2011 None
N/A
N/A
12/1/2011 None
N/A
1/23/2012 None
12/22/2008 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/5/2012 None
9/29/2009 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
6/27/2012 None
N/A
ACTIVE
ACTIVE
SAN ANTONIO TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/21/2011 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P3521
P4431
P1630
CHOWNING, SCOTT, MD
CHU, JEFFREY TING-YUAN, MD
CISNEROS, YVET LINDA, MD
P4744
11/1/2012
N2994
N3577
CLOUD, ROSE JOSEPH, MD
CONNOR, JEANMARIE BURIGO ,
MD
COOPER, MARCINA, MD
5/29/2009
8/21/2009
P1285
CORNELIUS, BEATRIZ , MD
11/4/2011
N7244
N9196
N1293
CORPUZ, GODDY TAPANG, MD
CORRIGAN, NICOLE JULIA, MD
COX, NATASHA LANAI, MD
P0568
N3588
CRAWFORD, HEATHER PAIGE, MD
CURBELO, NIURKA , MD
8/1/2011
8/21/2009
8/1/2016 PEDIATRICS
P2628
4/2/2012
4/2/2017 PEDIATRICS
N5644
DARBY, JOHN BYRON, MD
DAVENPORT, CRYSTAL MICHELLE,
MD
4/9/2010
4/9/2015 PEDIATRICS
N6122
DAVID, EMILIA , MD
6/4/2010
6/4/2015 PEDIATRICS
P5354
DAVIES, SUMMER DANIELLE, MD
DAVILA RODRIGUEZ, AMANDA
SOFIA, MD
DAVIS, LESLEY JOY, MD
2/1/2013
2/1/2018 PEDIATRICS
4/1/2013
7/15/2011
4/1/2018 PEDIATRICS
4/2/2012
4/2/2017 PEDIATRICS
P6370
DAVIS, REINA DANICA, MD
DE LA ROSA PEREZ, DEENI LUZ,
MD
5/1/2013
5/1/2018 PEDIATRICS
N9535
DE LEON, HECTOR EDUARDO, MD
5/2/2011
5/2/2016 PEDIATRICS
N3004
DEL RIO RODRIGUEZ, BETTY , MD
5/29/2009
P0370
N1304
DENNIS, ROBYN MONET, MD
DESCIOLI, KELLY RYANN, MD
P5957
P0367
P2630
Secondary Specialty
(Self-Designated)
6/8/2012
6/8/2017 PEDIATRICS
9/17/2012
12/15/2011 12/15/2016 PEDIATRICS
8/2/2010
8/2/2015 PEDIATRICS
4/1/2011
4/1/2016 PEDIATRICS
10/10/2008 10/10/2013 PEDIATRICS
7/15/2011
10/10/2008 10/10/2013 PEDIATRICS
Practice City
LONGVIEW
SUGARLAND
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
HOSPITALIST
PEDIATRICS
HOUSTON
TX
EL PASO
TX
MEDICAL GENETICS
SAN ANTONIO TX
PEDIATRICS
LUBBOCK
TX
KATY
TX
CORPUS
CHRISTI
HOUSTON
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HOUSTON
Page 244 of 301
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/8/2012 None
9/18/2012 None
12/29/2011 None
N/A
N/A
N/A
11/1/2012 None
N/A
6/8/2009 None
8/26/2009 None
N/A
N/A
11/4/2011 None
N/A
8/2/2010 None
4/11/2011 None
3/31/2009 None
N/A
N/A
N/A
8/1/2011 None
10/22/2009 None
N/A
N/A
4/2/2012 None
N/A
ACTIVE
LICENSE
ISSUED
4/30/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/11/2013 None
N/A
4/1/2013 None
8/1/2011 None
N/A
N/A
4/2/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/17/2013 None
N/A
5/2/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
6/3/2009 None
N/A
TX
ACTIVE
ACTIVE
7/21/2011 None
10/21/2008 None
N/A
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N3012
N4390
P0900
DESHPANDE, AVINASH SHRINIVAS,
MD
7/1/2011
7/1/2016 PEDIATRICS
DIAZ DE LEON, DAVID JR, MD
8/29/2008
DO, NHU QUYNH, MD
3/15/2012
DOAN, JANIE THAO, MD
12/1/2011
DOLLINS, KATHLEEN BOYD, MD
12/12/2008 12/12/2013 PEDIATRICS
DOUGLAS-ESCOBAR, MARTHA
VICTORIA , MD
5/29/2009
DURHAM, MEGAN RAE, MD
11/6/2009
DUVIC, MARGARET DENISE, DO
9/1/2011
9/1/2016 PEDIATRICS
P1988
EBRAHEEM, MOHAMMAD, MD
P1637
EGBORGE, ESEOVHE ALALIBO, MD
P2982
EKPENYONG, UDEME ISIDORE, MD
N9699
P6613
P0195
N0731
P2433
P1541
N1614
N4401
P6161
N7793
P2438
N9852
P4646
P2441
N8509
P4569
N0771
N2507
P4648
P6167
2/1/2012
2/1/2017 PEDIATRICS
5/1/2017 PEDIATRICS
EL MARAGHY, HALA RAAFAT, MD
ENGELHARDT, CANDACE, MD
ESCALONA-CRUZ, RELPHA
VAGILIDAD , MD
ESCOVAR, EKTA SAHEBA, MD
5/16/2011
5/15/2013
11/6/2009
4/12/2013
ESSANDOH, YVONNE ARABA, DO
ETOKHANA, KENNETH
OSHIOKHAYAMHE, MD
10/1/2010
3/15/2012
FRATTARELLI, TEASHA-LEE A, DO
FRAZIER, STACEY ANNE, MD
FREEMAN, ASHA MARIE, MD
FRISCHHERTZ, BENJAMIN PAUL,
MD
GADHIA, HETAL TALSI, DO
Practice City
PUNE,
MAHARASHTR
A
SAN ANTONIO
SPRING
HOUSTON
MCKINNEY
TX
TX
TX
TX
TX
HOUSTON
TX
DALLAS
TX
SAN ANTONIO TX
PEDIATRIC CRITICAL
CARE MEDICINE
12/15/2011 12/15/2016 PEDIATRICS
5/1/2012
EZON, DAVID STEVEN, MD
FAWEYA, AYOTUNDE GREGORY,
MD
FLORES, AMY WALLACE, MD
FLORES, ANGELA THERESE
CAPAY, MD
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
6/3/2011
6/3/2016 PEDIATRICS
MOBILE
FORT WORTH TX
JACKSONVILL
E
TX
BRONX
10/1/2012
8/29/2008
4/3/2009
4/3/2014 PEDIATRICS
10/15/2012 10/15/2017 PEDIATRICS
4/12/2013
NY
PEDIATRICS,
CARDIOLOGY
10/15/2012 10/15/2017 PEDIATRICS
3/15/2012
1/18/2011
AL
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status Date
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
6/15/2009 None
12/15/2009 None
11/3/2011 None
N/A
N/A
N/A
2/1/2012 None
N/A
ACTIVE
12/20/2011 None
N/A
5/7/2012 None
N/A
5/16/2011 None
5/22/2013 None
N/A
N/A
ACTIVE
ACTIVE
11/17/2009 None
4/17/2013 None
N/A
N/A
ACTIVE
10/6/2010 None
N/A
ACTIVE
LICENSE
ISSUED
3/21/2012 None
N/A
6/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
7/8/2011
9/8/2008
3/19/2012
12/6/2011
1/28/2009
Disciplinary
Status of
Texas
License
STARKE
FL
SAN ANTONIO TX
ACTIVE
ACTIVE
11/30/2012 None
3/26/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
1/31/2011 None
N/A
AKRON
LAS CRUCES
OH
NM
ACTIVE
ACTIVE
ACTIVE
10/4/2012 None
10/7/2008 None
5/7/2009 None
N/A
N/A
N/A
TX
SAN ANTONIO TX
Page 245 of 301
ACTIVE
ACTIVE
10/18/2012 None
4/23/2013 None
N/A
N/A
NEONATOLOGY
License
Number
N9548
N8652
Physician Name
GALLOWAY, LAURA JEAN, MD
GARCIA, CLARISA YSELA, MD
edicaid
edicaid
End Date
Designated)
5/2/2011
2/4/2011
Practice City
5/2/2016 PEDIATRICS
2/4/2016 PEDIATRICS
P0978
GARCIA, LUIS EDMUNDO, MD
9/15/2011
N7262
P4571
GARG, JYOTIKA, MD
GARZA, HOMERO , MD
8/2/2010
10/1/2012
8/2/2015 PEDIATRICS
P2117
N8654
GASSEN, JOSEPH ARISTIDE III, MD
GAW, LISA WUN KAM, MD
2/10/2012
2/4/2011
2/4/2016 PEDIATRICS
N1325
GENNRICH, MICHAEL JAMES, MD
P3627
GEORGIADIS, PARASKEVI, MD
6/15/2012
N2528
P1866
N9553
GHISOLI, MAURIZIO LORENZO, MD
GIBBONS, JANICE LYNN, MD
GIBBS, AUBREY CLARK, MD
4/3/2009
1/17/2012
5/2/2011
4/3/2014 PEDIATRICS
5/2/2016 PEDIATRICS
N8788
GOLDSTEIN, SARA B, DO
2/15/2011
N3683
GONZALEZ RANGEL, ISMAEL
ENRIQUE , MD
8/21/2009
N5691
GOTWAY, GARRETT KENNETH, MD
4/9/2010
4/9/2015 PEDIATRICS
N6882
N7427
7/1/2010
8/16/2010
7/1/2015 PEDIATRICS
N9215
GREUTER, AMANDA IRENE, MD
GUERRERO, ROY ANTONY, MD
GUILLORY, MARISA NOEL
HOLMES, MD
4/1/2011
4/1/2016 PEDIATRICS
N6332
GUPTA, RUCHI, MD
6/4/2010
6/4/2015 PEDIATRICS
N3704
GUPTHA, SUSHMA NAGARAJ , MD
8/21/2009
P0058
GUTIERREZ, DAVID SIMON, MD
GUTIERREZ, YESENIA FIGUEROA,
DO
6/15/2011
3/1/2011
3/1/2016 PEDIATRICS
N8922
Secondary Specialty
(Self-Designated)
PEDIATRICS,
CARDIOLOGY
RIO GRANDE
CITY.
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
PEDIATRICS
10/10/2008 10/10/2013 PEDIATRICS
AUSTIN
NEONATOLOGY
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
DALLAS
BIRMINGHAM
GENETICS
PEDIATRIC EMER
MED (PEDS)
TX
TX
AL
DALLAS
TX
UVALDE
TX
LITTLE ROCK
AR
MIDLAND
TX
FORT WORTH TX
Page 246 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/2/2011 None
N/A
2/4/2011 None
N/A
9/19/2011 None
N/A
8/2/2010 None
10/23/2012 None
N/A
N/A
2/10/2012 None
2/10/2011 None
N/A
N/A
10/20/2008 None
N/A
6/15/2012 None
N/A
5/4/2009 None
1/30/2012 None
5/18/2011 None
N/A
N/A
N/A
2/15/2011 None
N/A
11/19/2009 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/26/2010 None
N/A
7/1/2010 None
9/6/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/7/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/27/2009 None
N/A
6/15/2011 None
N/A
3/4/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
ACTIVE
License
Number
Physician Name
P3533
GUZMAN-ABLOG, MYLEEN, MD
N7096
P0059
edicaid
edicaid
End Date
Designated)
6/8/2012
6/8/2017 PEDIATRICS
HA, LINH THI MY, MD
HAAS, SALLY JASMINE, MD
7/15/2010
6/15/2011
N0813
HABIBA, NUSRATH MOHIDEEN, MD
8/29/2008
P3631
HAIN, PAUL DOUGLAS, MD
6/15/2012
P6407
N9710
P7118
P1460
P5375
P0600
HAKIM, HANA, MD
HANSON, ELIZABETH REED, MD
HARRIS, ANDREA DENISE, MD
HART, SUZANNE BARBARA, MD
HARTAS, GEORGIOS
ARISTOTELIS, MD
HASHAM, SARAH , MD
HATZENBUEHLER, LINDSAY ANN,
MD
HAYES, ERIEL WALLACE, MD
N8924
N9219
HEARDMON, SAMUEL JAVAR, MD
HEINTZ, D DYER, MD
N8790
HELMIG, SARA ELIZABETH, MD
N8012
HENRIQUEZ, ALFONSO JESUS, MD
N8657
P2996
P7461
5/1/2013
5/1/2018
5/16/2011
5/16/2016
7/1/2013
7/1/2018
11/15/2011 11/15/2016
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
2/4/2011
5/1/2012
2/4/2016 PEDIATRICS
5/1/2017 PEDIATRICS
2/1/2013
8/1/2011
2/1/2018 PEDIATRICS
8/1/2016 PEDIATRICS
3/1/2011
4/1/2011
3/1/2016 PEDIATRICS
4/1/2016 PEDIATRICS
2/15/2011
Secondary Specialty
(Self-Designated)
NEONATOLOGY
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
LICENSE
ISSUED
RICHARDSON TX
ACTIVE
N/A
7/15/2010 None
6/21/2011 None
N/A
N/A
9/8/2008 None
N/A
6/15/2012 None
N/A
5/1/2013
5/30/2011
7/8/2013
12/5/2011
None
None
None
None
N/A
N/A
N/A
N/A
2/4/2011 None
5/9/2012 None
N/A
N/A
2/7/2013 None
8/9/2011 None
N/A
N/A
3/14/2011 None
4/21/2011 None
N/A
N/A
2/15/2011 None
N/A
10/29/2010 None
N/A
8/7/2013 None
N/A
5/24/2011 None
N/A
8/15/2013 None
N/A
SAN ANTONIO TX
LICENSE
ISSUED
ACTIVE
4/1/2013 None
10/11/2011 None
N/A
N/A
HOUSTON
HOUSTON
ACTIVE
ACTIVE
5/11/2012 None
11/17/2009 None
N/A
N/A
TX
PEDIATRIC
INFECTIOUS
DISEASE
SAN ANTONIO TX
LAS CRUCES NM
PEDIATRICS,
CARDIOLOGY
8/1/2013
8/1/2018 PEDIATRICS
N9712
5/16/2011
P7646
HEREDIA, JACQUELINE , MD
8/15/2013
P5993
P1085
HOODA, BARKAT SADRUDDIN, MD
IDRIZI, HANEME , MD
4/1/2013
10/3/2011
4/1/2018 PEDIATRICS
P3006
N4493
IHEKWEAZU, FAITH DORSEY, MD
INTODY, ZSOFIA , MD
5/1/2012
11/6/2009
5/1/2017 PEDIATRICS
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
HOUSTON
TX
ACTIVE
ACTIVE
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
MOUNT
PLEASANT
CORPUS
CHRISTI
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
Page 247 of 301
ACTIVE
LICENSE
ISSUED
AMARILLO
10/29/2010 10/29/2015 PEDIATRICS
HENRY, MICHAEL DANIEL, MD
HENSLEY, KATHERINE
HAMPSHIRE, MD
Disciplinary
Status Date
6/8/2012 None
FT WORTH
INFECTIOUS
DISEASES
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
License
Number
Physician Name
N7706
ITKIN, PHILIP GAIL, MD
N6380
IVAN, DANIEL LUCIAN, MD
edicaid
edicaid
End Date
Designated)
9/15/2010
6/4/2010
6/4/2015 PEDIATRICS
N8308
N3761
JAIN, VIPIN KUMAR, MD
JI, JIANZHONG , MD
N6389
N8669
6/4/2010
2/4/2011
6/4/2015 PEDIATRICS
2/4/2016 PEDIATRICS
N5139
JILANI, SEEMA M, MD
JOHNSON, KELLY ANNETTE, MD
KADAKOL, AMITHA
KRISHNAMURTHY, MD
2/5/2010
2/5/2015 PEDIATRICS
P2271
KAFERLY, JAMES GABEL III, MD
3/1/2012
3/1/2017 PEDIATRICS
P0241
P1881
P7477
12/15/2010 12/15/2015 PEDIATRICS
8/21/2009
7/1/2011
1/17/2012
8/1/2013
7/1/2016 PEDIATRICS
8/1/2018 PEDIATRICS
N8526
KAISER, JACOB BRIAN, DO
KALLADA, SAHLA, MD
KAMDAR, ADITI BHARAT, MD
KANCHERLA, SHAILAJA REDDY,
MD
1/18/2011
N8803
KHAMBATY, SHABBIR , MD
2/15/2011
P3640
L8761
KHAN, OWAIS AHMED, MD
KHANDELWAL, SUSAN KURUVILLA,
MD
6/15/2012
5/15/2012
N9244
N8940
P6663
KHATEEB, NAILA IMRAN, MD
KHATUA, SUTAPA, MD
KISSEL, ABIGAIL MARION, MD
4/1/2011
3/1/2011
5/15/2013
4/1/2016 PEDIATRICS
3/1/2016 PEDIATRICS
N5784
N8677
N3122
KNUDSON, JARROD DOW, MD
KORDY, KATTAYOUN , MD
KOSTUR, GREGORY DANIEL, MD
4/9/2010
2/4/2011
5/29/2009
4/9/2015 PEDIATRICS
2/4/2016 PEDIATRICS
P0250
P2709
KOTTO-KOME GARCIA-SALAS,
ANNE CATHERINE ALBERTINE, MD
KRISHNAN, NIVEDITA, MD
7/1/2011
4/2/2012
7/1/2016 PEDIATRICS
4/2/2017 PEDIATRICS
N6439
KRISHNAPPA, ANURADHA, MD
6/4/2010
6/4/2015 PEDIATRICS
Secondary Specialty
(Self-Designated)
ADOLESCENT
MEDICINE - PD
Practice City
OMAHA
Registration
Status of
Practice
Texas
State
License
10/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/6/2011 None
8/28/2009 None
N/A
N/A
6/4/2010 None
2/11/2011 None
N/A
N/A
2/5/2010 None
N/A
3/1/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
7/11/2011 None
1/23/2012 None
9/9/2013 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
1/28/2011 None
N/A
2/15/2011 None
N/A
IL
ACTIVE
6/27/2012 None
N/A
6/11/2012 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
4/1/2011 None
3/7/2011 None
5/23/2013 None
N/A
N/A
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/14/2010 None
2/11/2011 None
6/29/2009 None
N/A
N/A
N/A
7/1/2011 None
4/9/2012 None
N/A
N/A
6/4/2010 None
N/A
IL
TX
WICHITA
FALLS
TX
TAYLORVILLE IL
DUNN
NEONATALPERINATAL
MEDICINE
CHICAGO
NC
PEDIATRIC
ENDOCRINOLOGY
PEDIATRICS,
CARDIOLOGY
NEONATOLOGY
Page 248 of 301
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
OTOLOGY/NEUTOTO MOUNT
LOGY
VERNON
AUSTIN
NE
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P0620
KUDAKKASSERIL, ANUP S, MD
N4533
P0076
N5168
KULKARNI, ARCHANA GOVIND, MD
KULKARNI, MADHULIKA
ALLAWADHI, MD
edicaid
edicaid
End Date
Designated)
8/1/2011
8/1/2016 PEDIATRICS
11/6/2009
6/15/2011
2/5/2010
2/5/2015 PEDIATRICS
2/5/2010
2/5/2015 PEDIATRICS
N5170
KUMAR, ASHU , DO
KUMAR, DOMALAPALLI MANEESH,
DO
P6989
KUO, JEFF, MD
6/14/2013
N5174
N3807
LABUDA, SARAH , MD
LALWANI, SONESH KUMAR, MD
2/5/2010
8/21/2009
2/5/2015 PEDIATRICS
P0078
LAMA-BRISENO, TRACY R, DO
6/15/2011
N6445
P3186
LANG, CATHLEEN ANN, MD
LARA, ANNA KOPIECZEK, MD
6/4/2010
5/15/2012
6/4/2015 PEDIATRICS
N5799
LARSEN, REAGAN , MD
4/9/2010
4/9/2015 PEDIATRICS
N6450
LAZOL, JUDITH PANERGO, MD
6/4/2010
6/4/2015 PEDIATRICS
P3376
N8417
LE, Y THANH, DO
LEE, ROBERT NIEN HUA, DO
6/1/2012
1/3/2011
6/1/2017 PEDIATRICS
1/3/2016 PEDIATRICS
P7144
LEGER, KASEY JOANNE, MD
P6993
N9464
7/1/2013
7/1/2018 PEDIATRICS
6/14/2013
4/15/2011
8/29/2008
4/15/2011
P2287
LEHMANN, ANA ROSA, MD
LI, LI , MD
LIBED, CHERRYLL PHOEBE
TARUC, MD
LITTLE, JENELLE EDEN, MD
LLOREN, CHARISSE CASTELLANO,
MD
3/1/2012
3/1/2017 PEDIATRICS
P0849
LOPEZ, MARCO ANTONIO, MD
8/26/2011
N0924
N9465
Secondary Specialty
(Self-Designated)
NEONATALPERINATAL
MEDICINE
PEDIATRIC EMER
MED (PEDS)
Registration
Status of
Practice
Texas
Practice City
State
License
HARRISBURG PA
ACTIVE
AMARILLO
TX
ACTIVE
HOUSTON
TX
1/6/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/20/2011 None
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/18/2013 None
N/A
2/5/2010 None
9/8/2009 None
N/A
N/A
6/15/2011 None
N/A
6/4/2010 None
6/15/2012 None
N/A
N/A
4/9/2010 None
N/A
6/4/2010 None
N/A
6/1/2012 None
1/13/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
7/24/2013 None
N/A
6/14/2013 None
4/29/2011 None
N/A
N/A
FORT WORTH TX
ACTIVE
ACTIVE
9/15/2008 None
4/20/2011 None
N/A
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
3/14/2012 None
N/A
8/26/2011 None
N/A
PEDIATRIC
FORENSIC MEDICINE PAMPA
MCALLEN
HOUSTON
TX
TX
TX
CARDIOLOGY
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
DALLAS
Page 249 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/8/2011 None
N/A
TX
TX
License
Number
Physician Name
N1742
LOPEZ, MICHELLE ANN, MD
N5203
P3192
P4592
P6674
N4573
P1354
P0760
LOT, LUCY , MD
MACIAS CEDENO, FRANZ WILLIAM,
MD
MACK, TOREY L, MD
MALONE, LOREN, MD
MANDLIK, NANDINI ANANYA, DO
MANONGAS, MARIA AURORA
RAYPON, MD
MANSOOR, SABA, MD
edicaid
edicaid
End Date
Designated)
12/12/2008 12/12/2013 PEDIATRICS
2/5/2010
2/5/2015 PEDIATRICS
5/15/2012
10/1/2012
5/15/2013
11/6/2009
11/4/2011
8/15/2011
N8034
MANZAR, SHABIH, MD
10/29/2010 10/29/2015 PEDIATRICS
N1387
10/10/2008 10/10/2013 PEDIATRICS
P5840
MANZURI, SHAI , MD
MARIANO, MARIA RIZZA DELIZO,
MD
N3867
MARROQUIN, JACLYN TERESA, MD
P7501
MARTINEZ, BRENDA NOEMI, MD
N3871
P6676
P7669
MARUVADA, SREEKAR , MD
MARX, JULIE ERICA, MD
MATHEW, NEETHU MUPPADHYIL,
MD
P2492
MBADUGHA, IFEANYI M, MD
P6030
P7505
MCBETH, KATRINA ELIZABETH, MD
MCCANN-CROSBY, BONNIE MARIE,
MD
MCCORMICK, SARAH
MARGUERITE, DO
P0094
N9265
MCGILL-VARGAS, LISA LYNN, MD
MCKEY, JOANNA LYNN, MD
P1897
Secondary Specialty
(Self-Designated)
Practice City
BROOKLYN
NEONATOLOGY
HOUSTON
PEDIATRIC CRITICAL
CARE MEDICINE
DALLAS
PLEASANTON
NEONATALPERINATAL
MEDICINE
CRITICAL CARE
MEDICINE
DALLAS
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
2/5/2010 None
N/A
5/18/2012 None
10/3/2012 None
N/A
N/A
5/20/2013 None
11/24/2009 None
N/A
N/A
11/4/2011 None
8/23/2011 None
N/A
N/A
LICENSE
ISSUED
10/29/2010 None
N/A
ACTIVE
10/15/2008 None
N/A
3/20/2013 None
N/A
9/4/2009 None
N/A
8/1/2013 None
N/A
ACTIVE
ACTIVE
8/28/2009 None
6/12/2013 None
N/A
N/A
ACTIVE
8/22/2013 None
N/A
NY
TX
ACTIVE
ACTIVE
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
3/15/2013
ACTIVE
8/21/2009
8/1/2013
8/1/2018 PEDIATRICS
ACTIVE
LICENSE
ISSUED
8/21/2009
5/15/2013
8/15/2013
3/15/2012
4/1/2013
4/1/2018 PEDIATRICS
1/17/2012
8/1/2013
8/1/2018 PEDIATRICS
6/15/2011
4/1/2011
4/1/2016 PEDIATRICS
HOSPITALIST
PEDIATRICS
PEDIATRIC
PULMONOLOGY
LAKE
JACKSON
DALLAS
TX
TX
CORPUS
CHRISTI
TX
ACTIVE
3/20/2012 None
N/A
HOUSTON
TX
ACTIVE
4/3/2013 None
N/A
HOUSTON
TX
ACTIVE
1/23/2012 None
N/A
TEMPLE
TX
8/6/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
6/15/2011 None
4/21/2011 None
N/A
N/A
NEONATOLOGY
Page 250 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/30/2009 None
N/A
License
Number
N6925
Physician Name
edicaid
edicaid
End Date
Designated)
7/1/2015 PEDIATRICS
Practice City
LICENSE
ISSUED
4/3/2009
5/15/2013
4/3/2014 PEDIATRICS
HOSPITALIST
N3882
MCKINNEY, JEFFREY SCOTT, MD
MCKNIGHT, HEATHER MICHELLE,
MD
MCLAURIN, LATISHA , MD
MCMILLAN, ADRIENNE MONICA,
MD
8/21/2009
P0095
MEADOWS, MILTON WILLIAM, MD
6/15/2011
P7160
7/1/2013
7/1/2018 PEDIATRICS
P1361
MELLA, CESAR FRANCISCO, MD
MENDIOLA, ANNA MARIE TEENA
CAPULONG, MD
DALLAS
PEDIATRIC CRITICAL
CARE MEDICINE
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
11/4/2011
N7145
P4893
MERCADO, LEAH ALBANO, MD
MILLS, ALICIA E, MD
P0639
MILNER, JENNIFER NICOLE, MD
N7843
N2650
P6678
7/1/2010
Secondary Specialty
(Self-Designated)
PEDIATRIC
INFECTIOUS
DISEASE
Registration
Status of
Practice
Texas
State
License
ALBUQUERQU
E
NM
LUBBOCK
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/1/2010 None
N/A
ACTIVE
ACTIVE
4/9/2009 None
5/17/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
8/26/2009 None
N/A
6/15/2011 None
N/A
7/3/2013 None
N/A
11/11/2011 None
N/A
7/15/2010 None
11/26/2012 None
N/A
N/A
8/1/2011 None
N/A
10/1/2010 None
N/A
TX
ACTIVE
EL PASO
TX
MANSFIELD
TX
8/1/2011
8/1/2016 PEDIATRICS
MITCHELL, KRISTINA OREY, MD
MOLLEDA CASTRO, IMGARD
CAROLINA, MD
MONTGOMERY, ELIZABETH GAIL,
MD
MOORE, VICKI PHILLIPS, DO
MOREIRA, ALVARO G., MD
10/1/2010
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/1/2010
ACTIVE
10/5/2010 None
N/A
8/29/2008
1/3/2011
8/21/2009
1/3/2016 PEDIATRICS
1/21/2009 None
1/13/2011 None
9/18/2009 None
N/A
N/A
N/A
4/9/2010
4/9/2015 PEDIATRICS
4/9/2010 None
N/A
N5264
N9102
P5849
N3922
P1370
P6474
M0836
MORGAN, JESSICA ANNE, MD
MORRISSEY, WILLIAM JOSEPH JR,
MD
MUEHE, NATALI MATTERN, MD
MUNIZ, MANUEL R, MD
MUSACCHIO, NAJAH SENNO, MD
NAGA, OSAMA IBRAHIM, MD
NAGARAJ, SUMA, MD
NAGDA, RABIA MEHR, MD
2/5/2010
3/15/2011
3/15/2013
8/21/2009
11/4/2011
5/1/2013
11/6/2009
2/5/2015
3/15/2016
3/15/2018
8/21/2014
11/4/2016
5/1/2018
11/6/2014
N7316
N8431
N3206
NAIR, JYOTI GOVINDAN, MD
NATTIV, ROY, MD
NEAD, JENNIFER ANNE , MD
8/2/2010
1/3/2011
5/29/2009
8/2/2015 PEDIATRICS
1/3/2016 PEDIATRICS
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
N7844
N0994
N8427
N3906
N5888
7/15/2010
11/15/2012 11/15/2017 PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
NEONATOLOGY
DALLAS
GALVSTON
TX
TX
PEDIATRIC EMER
MED (PEDS)
PEDIATRICS
HOSPITALIST
Page 251 of 301
DENISON
DALLAS
BEAUMONT
TX
TX
TX
HOUSTON
TX
HOUSTON
TX
2/5/2010
4/19/2011
4/1/2013
9/28/2009
12/1/2011
5/3/2013
11/19/2009
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
8/2/2010 None
1/6/2011 None
6/8/2009 None
N/A
N/A
N/A
License
Number
Physician Name
P3213
NEMATI, PROSHAD, MD
N3947
NICHITA, SIMONA , MD
N5285
NIEVES CRUZ, BEDFORD , MD
P0266
NIU, MARY C, MD
NNEBE, FLORENCE ONYEBUCHI,
MD
OGUNDIPE, OLUKEMI , MD
N3950
P1203
N4636
N4637
P1007
P5699
N8331
N1035
N5301
P3404
OLAJIDE, BOLANLE ABIMBOLA, MD
OLAYA, JORGE EDUARDO , MD
OLOTU, ADETOKUNBO
OLUWAYEMISI, MD
OLSON, KELLY ANN, MD
ONYEAMA, CHARLES
OKECHUKWU, MD
ONYIORAH, CLETUS EMEKA, MD
OSBORN, AMBIKA NICOLE, MD
OSMAN, KWABENA AGYAPONG,
MD
N6554
N3223
N9760
PAEZ, ANA MARIA, MD
PAGAN, CARMEN JUDITH, MD
PALMER, CELESTE D, MD
P5444
N2711
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
5/15/2012
ANESTHESIOLOGY
8/21/2009
NEONATALPERINATAL
2/5/2010
2/5/2015 PEDIATRICS
MEDICINE
PEDIATRICS,
7/1/2011
7/1/2016 PEDIATRICS
CARDIOLOGY
8/21/2009
10/17/2011 10/17/2016 PEDIATRICS
Practice City
LAS CRUCES
Registration
Status of
Practice
Texas
State
License
ACTIVE
NM
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
5/17/2012 None
N/A
8/26/2009 None
N/A
2/5/2010 None
N/A
HOUSTON
TX
ACTIVE
7/27/2011 None
N/A
EL PASO
HOUSTON
TX
TX
ACTIVE
ACTIVE
8/27/2009 None
10/26/2011 None
N/A
N/A
11/6/2009
11/6/2009
BROOKLYN
EAGLE PASS
NY
TX
ACTIVE
ACTIVE
12/2/2009 None
1/27/2010 None
N/A
N/A
9/15/2011
3/1/2013
3/1/2018 PEDIATRICS
EL PASO
TX
ACTIVE
ACTIVE
10/14/2011 None
3/8/2013 None
N/A
N/A
12/15/2010 12/15/2015 PEDIATRICS
8/29/2008
GRANTS
ABILENE
NM
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
12/30/2010 None
9/17/2008 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/15/2012 None
N/A
6/4/2010 None
6/22/2009 None
6/3/2011 None
N/A
N/A
N/A
2/8/2013 None
5/15/2009 None
N/A
N/A
6/4/2010 None
1/6/2011 None
N/A
N/A
1/3/2011 None
6/16/2009 None
N/A
N/A
7/11/2011 None
7/21/2011 None
N/A
N/A
2/5/2010
2/5/2015 PEDIATRICS
6/1/2012
6/1/2017 PEDIATRICS
PEDIATRIC
ENDOCRINOLOGY
PEDIATRICS
6/4/2010
5/29/2009
5/16/2011
6/4/2015 PEDIATRICS
PANITHI, RANJANI, MD
PANKAJ, SHILPA THAKKAR, MD
2/1/2013
4/3/2009
2/1/2018 PEDIATRICS
4/3/2014 PEDIATRICS
BAKERSFIELD CA
HOUSTON
TX
N6558
N8439
PANKRATZ, MICHAL MARIE, MD
PARLOW, SUSAN, MD
6/4/2010
1/3/2011
6/4/2015 PEDIATRICS
1/3/2016 PEDIATRICS
LUBBOCK
DALLAS
TX
TX
N8440
N3232
PARRA, THELMA GAYTAN, MD
PARTAP, ANU NITA, MD
1/3/2011
5/29/2009
1/3/2016 PEDIATRICS
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
P0268
P0468
PATEL, MEHUL DILIP, MD
PATEL, SANJAY H, DO
7/1/2011
7/15/2011
7/1/2016 PEDIATRICS
DALLAS
MIDLAND
TX
TX
ACTIVE
ACTIVE
PEDIATRICS,
CARDIOLOGY
Page 252 of 301
LA JOYA
HOUSTON
TX
TX
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P1207
P1011
PATEL, SIMA BALUBHAI, MD
PATHAK, INDU S, MD
10/17/2011 10/17/2016 PEDIATRICS
9/15/2011
P5870
PATNI, NIVEDITA , MD
3/15/2013
N7160
PEINADO FRAGOSO, JESUS, MD
7/15/2010
Secondary Specialty
(Self-Designated)
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
PEDIATRIC
ENDOCRINOLOGY
Practice City
ACTIVE
ACTIVE
11/3/2011 None
9/21/2011 None
N/A
N/A
MIAMI
FL
ACTIVE
LICENSE
ISSUED
4/23/2013 None
N/A
7/15/2010 None
N/A
9/5/2008 None
N/A
8/29/2008
N1059
8/29/2008
DALLAS
N7571
PETERSON, CHRISTY, MD
8/27/2010
P3222
N4673
P1131
P3061
N3998
N5952
PEZZULLO, ROSEMARIE ANNE, MD
PIRRAGLIA, PETER DOMINIC, MD
POLLARD, KATHLEEN ROSE, MD
POMEROY, BRIAN JAMES, MD
POSHOGHLIAN, HAGOP , MD
PREISBERGA, KRISTA, MD
5/15/2012
11/6/2009
10/3/2011
5/1/2012
8/21/2009
4/9/2010
5/15/2017
11/6/2014
10/3/2016
5/1/2017
8/21/2014
4/9/2015
P0118
N4006
PURANIK, NIRANJAN , MD
QIAN, BAOPING , MD
6/15/2011
8/21/2009
N5956
RAFATI, DANNY SALAH, MD
4/9/2010
4/9/2015 PEDIATRICS
P0472
RAGHUTHAMAN, THARA, MD
N6596
RAMMAGE, JENNIFER LEIGH, MD
P6706
RAMPRASAD, JONATHAN ROBERT,
MD
RANNULU, SUDATH GUNADEERA,
MD
RATLIFF, JEANINE LOUISE DAVIS,
MD
P7695
RAZVI, SHEHLA SYED, MD
N9284
P7550
7/15/2011
6/4/2010
6/4/2015 PEDIATRICS
4/1/2011
4/1/2016 PEDIATRICS
8/1/2013
8/1/2018 PEDIATRICS
5/15/2013
8/15/2013
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
11/10/2008 None
N/A
8/27/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
5/21/2012
11/24/2009
10/31/2011
5/15/2012
8/31/2009
4/29/2010
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
6/15/2011 None
8/26/2009 None
N/A
N/A
4/9/2010 None
N/A
7/21/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
4/6/2011 None
N/A
TX
ACTIVE
8/16/2013 None
N/A
TX
ACTIVE
5/31/2013 None
N/A
TX
ACTIVE
9/9/2013 None
N/A
ISLAND PARK
NY
LUBBOCK
HOUSTON
CHICAGO
TX
TX
IL
PLAINVIEW
TX
PEDIATRIC
NEUROLOGY
PEDIATRIC
GASTROENTEROLOG
Y
ADOLESCENT
MEDICINE - PD
CEDAR HILL
PEDIATRICS
GALVESTON
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
Page 253 of 301
Disciplinary
Status Date
TX
TX
PENA LOPEZ, OMAR JOSE, MD
PENGETNZE, YOLANDE
MFONDOUM, MD
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
EL PASO
ELSA,
HIDALGO
COUNTY
N1058
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N7654
P1133
P6898
REDDY, ASHWINI PASUNOORI, MD
REEDER, KRISTEN NICOLE, MD
RELPH, ANDREW JAMES, DO
P6511
P7554
N5969
REMICK, KATHERINE ELIZABETH,
MD
REMSTER, ERIC MICHAEL, MD
REYNA, RICARDO III, MD
P6255
P4903
P7341
P0480
RIBEIRO, ANNELISE NATASHA, MD
RIEBEL, HEATHER ROSE, MD
RIGGS, JENNIFER LYNN, MD
ROBINSON, CHRISTINA, MD
P6258
4/12/2013
1/4/2013
1/4/2018 PEDIATRICS
P0871
RODGERS, KATHERINE ANNA, MD
RODRIGUEZ MUNOZ, MARIA
VICTORIA, MD
RODRIGUEZ, MARISOL LOREDO,
MD
8/26/2011
N4708
RODRIGUEZ-RICO, DANIELLA , MD
11/6/2009
N4046
P2919
P6071
ROSAS BLUM, EDUARDO DANIEL,
MD
RUAS, VIRGINIA LAURA, MD
SABRI, NADIA A, MD
8/21/2009
4/13/2012
4/1/2013
4/1/2018 PEDIATRICS
3/15/2011
6/8/2012
6/8/2017 PEDIATRICS
1/4/2013
1/4/2018 PEDIATRICS
P5231
N9123
P3575
P5234
SAENZ, PAULINA ALEJANDRA, MD
SAGHIER, SADAF, MD
SALAKO, OLUBUNMI NKEM
ADEKUMBI, MD
P0928
K0183
SALAMI, OLUFUNMILAYO I, MD
SALEEM, ASMA, MD
N3409
SALEEM, MARIAM , MD
P3576
SALINAS, CRYSTAL MICHELLE, MD
9/1/2010
10/3/2011
6/3/2013
5/1/2013
8/1/2013
4/9/2010
9/1/2015 PEDIATRICS
6/3/2018 PEDIATRICS
5/1/2018 PEDIATRICS
8/1/2018 PEDIATRICS
4/9/2015 PEDIATRICS
4/12/2013
11/15/2012 11/15/2017 PEDIATRICS
7/15/2013
7/15/2011
9/1/2011
2/1/2013
9/1/2016 PEDIATRICS
2/1/2018 PEDIATRICS
8/21/2009
6/8/2012
6/8/2017 PEDIATRICS
Secondary Specialty
(Self-Designated)
OTHER SPECIALTY
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
NEUROLOGY
PEDIATRIC
NEPHROLOGY
HOSPITALIST
Practice City
DALLAS
AMARILLO
TX
TX
ACTIVE
ACTIVE
ACTIVE
AUSTIN
DALLAS
EL PASO
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
QUITMAN
SAN ANTONIO
ODESSA
SAN ANGELO
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DALLAS
CORPUS
CHRISTI
TX
TX
PHARR
PEDIATRIC
GASTROENTEROLOG
Y
HOUSTON
ARLINGTON
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Page 254 of 301
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/6/2010 None
12/5/2011 None
6/7/2013 None
N/A
N/A
N/A
5/17/2013 None
8/20/2013 None
4/15/2010 None
N/A
N/A
N/A
4/16/2013
11/26/2012
7/18/2013
7/21/2011
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
4/24/2013 None
N/A
ACTIVE
LICENSE
ISSUED
2/28/2013 None
N/A
8/26/2011 None
N/A
TX
ACTIVE
11/30/2009 None
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
9/3/2009 None
4/20/2012 None
4/10/2013 None
N/A
N/A
N/A
TEMPLE
TX
4/4/2011 None
6/26/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
1/4/2013 None
N/A
ACTIVE
ACTIVE
9/28/2011 None
2/25/2013 None
N/A
N/A
MINNEAPOLIS MN
RIO GRANDE
CITY
TX
ACTIVE
11/4/2009 None
N/A
AUSTIN
TX
ACTIVE
6/14/2012 None
N/A
License
Number
N7169
N8569
N5997
P7201
N2778
P7031
N6641
Physician Name
SAMUELS, MARTEL GEORGE, MD
SANCHEZ IGLESIAS, GERVASIO A,
MD
SANGUINETTI-COLON, YIRIELIS ,
MD
SARRAFF, MICHELLE ANN, MD
SAUL-SEHY, CHERYL LYNN, MD
SAWYERR, THOMAS NEMAHUN,
MD
SCHEIDEMAN, ERIN ELIZABETH,
MD
P6262
N4731
P3241
SCHLEGEL, CHELSEA ROSE, MD
SCOTT, LAUREL ALLISON, MD
SENGUPTA, PIYALI DAS, MD
N9954
edicaid
edicaid
End Date
Designated)
7/15/2010
1/18/2011
4/9/2010
7/1/2013
4/3/2009
4/9/2015 PEDIATRICS
7/1/2018 PEDIATRICS
4/3/2014 PEDIATRICS
SAN ANGELO
TEXARKANA
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
6/14/2013
CORSICANA
TX
6/4/2010
6/4/2015 PEDIATRICS
4/12/2013
11/6/2009
5/15/2012
SENS, ASHLEY E, MD
6/3/2011
6/3/2016 PEDIATRICS
P2362
SERRETTE, JUSTIN MICHAEL, MD
3/1/2012
3/1/2017 PEDIATRICS
P4709
P0494
P7704
P3242
N4084
SESHADRI, SHESHASHREE, MD
SHAH, ARATHI APURVA, MD
SHAH, AVNI ASHOK, DO
SHAH, JAY NARESH, DO
SHAH, NINA , DO
N6654
P7206
N6995
SHAH, ULKA KISHOR-NIRAJ, MD
SHANKER, SHRUTI, DO
SHANLEY, LETICIA AURORA, MD
N6017
N4094
SHEPHERD, LONI LYNN, MD
SHETGIRI, RASHMI , MD
P4613
SIFUENTES-DOMINGUEZ, LUIS
FERNANDO, MD
N5403
N9302
N8988
SILVA MUSALEM, MARIEL , MD
SINGH, AMRITA , MD
SKELTON, HILLARY ALAINE, MD
Secondary Specialty
(Self-Designated)
Practice City
ALLERGY AND
IMMUNOLOGY
SUGAR LAND
DICKINSON
GALVESTON
CORPUS
CHRISTI
SAN ANTONIO
AUSTIN
10/15/2012 10/15/2017 PEDIATRICS
7/15/2011
8/15/2013
5/15/2012
8/21/2009
TX
TX
TX
ACTIVE
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
6/4/2010
7/1/2013
7/1/2010
6/4/2015 PEDIATRICS
7/1/2018 PEDIATRICS
7/1/2015 PEDIATRICS
4/9/2010
8/21/2009
4/9/2015 PEDIATRICS
DALLAS
TX
10/1/2012
PEDIATRIC
GASTROENTEROLOG
Y
DALLAS
TX
2/5/2010
4/1/2011
3/1/2011
2/5/2015 PEDIATRICS
4/1/2016 PEDIATRICS
3/1/2016 PEDIATRICS
HOSPITALIST
TX
SAN ANTONIO TX
DALLAS
TX
Page 255 of 301
HOUSTON
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/15/2010 None
N/A
1/18/2011 None
N/A
4/9/2010 None
7/9/2013 None
4/10/2009 None
N/A
N/A
N/A
7/16/2013 None
N/A
6/4/2010 None
N/A
4/12/2013 None
11/12/2009 None
5/24/2012 None
N/A
N/A
N/A
6/3/2011 None
N/A
3/9/2012 None
N/A
10/18/2012
7/20/2011
8/29/2013
6/19/2012
9/3/2009
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
6/4/2010 None
7/12/2013 None
7/27/2010 None
N/A
N/A
N/A
4/9/2010 None
8/26/2009 None
N/A
N/A
10/2/2012 None
N/A
2/5/2010 None
4/7/2011 None
3/23/2011 None
N/A
N/A
N/A
License
Number
P1927
Physician Name
edicaid
edicaid
End Date
Designated)
1/17/2012
N4113
N8989
N2302
SMITH, EBONI MIKELLE, MD
SMITH, ELIZABETH ANN ROCHE,
MD
SMITH, JOSHUA MICHAEL, MD
SMITH, JUSTIN RAY, MD
8/21/2009
3/1/2011
2/6/2009
3/1/2016 PEDIATRICS
2/6/2014 PEDIATRICS
N5411
P3670
P2534
P4616
SOLANO, ILIANA , MD
SOSA, JACQUELINE QUINN, MD
SPENCE, TIMOTHY AARON, MD
SRINIVAS, GOWRI SHASHI, MD
2/5/2010
6/15/2012
3/15/2012
10/1/2012
2/5/2015
6/15/2017
3/15/2017
10/1/2017
N7352
STERN, HERBERT JOEL, MD
8/2/2010
8/2/2015 PEDIATRICS
N9311
4/1/2011
4/1/2016 PEDIATRICS
6/4/2010
6/4/2015 PEDIATRICS
P0142
N2832
SUNDERLAND, KELLY M, MD
SUREKA, ASHISH OMPRAKASH,
MD
SUTCLIFFE, DAVID LAWRENCE,
MD
TANNER, DENNIS JAMES, MD
6/15/2011
4/3/2009
4/3/2014 PEDIATRICS
N8997
N4147
P7861
P5897
TANNOUS, ANN FAYEZ, MD
TANNOUS, BEATRICE , MD
TANWAR-AHUJA, MEENA, MD
TARASEVICIUTE, AGNE , MD
3/1/2011
8/21/2009
8/30/2013
3/15/2013
3/1/2016
8/21/2014
8/30/2018
3/15/2018
P6926
TAUSEEF, MUHAMMAD ASIF, MD
N6700
P7581
N5430
N4152
P7218
TENGSUPAKUL, SUPATIDA, MD
TESORERO TENGCO, MAFALDA
DIAZ, MD
TETTEH, SHIRLEY , MD
THACKER, ANMONA S, MD
L4146
P3084
THAMMASITBOON, SATID, MD
THOMAS, ANSA MARIN, MD
N6067
P1146
THOMAS, ELIZABETH RACHEL, DO
THOMAS, MARTHA DIANNA, MD
6/3/2013
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
Secondary Specialty
(Self-Designated)
PEDIATRICS
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
1/26/2012 None
N/A
HOUSTON
DALLAS
ABILENE
TX
TX
TX
9/7/2009 None
3/4/2011 None
2/10/2009 None
N/A
N/A
N/A
WA
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
2/5/2010
6/19/2012
3/27/2012
10/5/2012
None
None
None
None
N/A
N/A
N/A
N/A
TX
ACTIVE
8/5/2010 None
N/A
OK
ACTIVE
LICENSE
ISSUED
4/14/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
6/20/2011 None
4/13/2009 None
N/A
N/A
3/1/2011
10/2/2009
9/10/2013
3/19/2013
None
None
None
None
N/A
N/A
N/A
N/A
SHREVEPORT LA
ACTIVE
6/13/2013 None
N/A
MCALLEN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/2/2013 None
N/A
2/5/2010 None
9/1/2009 None
7/16/2013 None
N/A
N/A
N/A
2/14/2011 None
5/17/2012 None
N/A
N/A
4/9/2010 None
10/18/2011 None
N/A
N/A
TACOMA
DALLAS
CORPUS
CHRISTI
OKLAHOMA
CITY
DALLAS
DALLAS
PEDIATRICS
PEDIATRICS
PEDIATRICS
PEDIATRICS
TX
TX
FORT WORTH TX
6/3/2018 PEDIATRICS
PEDIATRIC
INFECTIOUS
DISEASE
8/1/2013
8/1/2018 PEDIATRICS
2/5/2010
8/21/2009
7/1/2013
2/5/2015 PEDIATRICS
7/1/2018 PEDIATRICS
DALLAS
HOUSTON
TX
TX
2/4/2011
5/1/2012
2/4/2016 PEDIATRICS
5/1/2017 PEDIATRICS
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
DALLAS
TX
TX
4/9/2010
10/3/2011
4/9/2015 PEDIATRICS
PEDIATRICS
GAINESVILLE
Page 256 of 301
Disciplinary
Status Date
HOUSTON
PEDIATRICS
PEDIATRICS,
CARDIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
N6716
P0309
N3350
THYSSEN, ELIZABETH ANN, DO
TIDROSKI, JENNIFER EVANS, DO
TILLEY, MELISSA MAE, MD
N6719
TOLIA, DEEPTI M, DO
N6720
P7718
P3261
TOLIA, VEERAL N, MD
TORRES SANTOS, JUAN
EDUARDO, MD
TRUCKENBROD, JAYNE SUZANNE,
DO
TRUONG, HUNG HOANG, MD
P0936
N7363
N8588
TUNUGUNTLA, HARI PRIYA, MD
UMAIR, SONOBER, MD
URANGA, JOE ANTHONY, MD
N5448
VAID, REENA MOZA, MD
N7595
N4176
N4817
N8589
edicaid
edicaid
End Date
Designated)
6/4/2010
7/1/2011
5/29/2009
6/4/2015 PEDIATRICS
7/1/2016 PEDIATRICS
6/4/2010
6/4/2015 PEDIATRICS
6/4/2010
6/4/2015 PEDIATRICS
1/4/2013
1/4/2018 PEDIATRICS
8/15/2013
5/15/2012
9/1/2011
8/2/2010
1/18/2011
9/1/2016 PEDIATRICS
8/2/2015 PEDIATRICS
2/5/2010
2/5/2015 PEDIATRICS
VALAVALKAR, SUBHASHINI S, MD
VALDES ROQUE, ANA I , MD
VALENZUELA, EDUARD , MD
8/27/2010
8/21/2009
11/6/2009
1/18/2011
N8070
VARGHESE, TESSY ANN, MD
VASYLYEVA, TETYANA
LEONIDIVNA, MD
N7371
VEGA FERNANDEZ, PATRICIA , MD
P4524
N9324
VERMA, PRAGYA PREMKUMAR,
MD
VERSHAW, ANNA , MD
P5242
N8740
P0316
P3479
VIJAYAMADHAVAN, VIVEK KUMAR,
MD
VILLAROSA, MELANIO PASOS II,
MD
VILLARREAL, BRIAN ALLEN, MD
10/29/2010 10/29/2015 PEDIATRICS
8/2/2010
8/2/2015 PEDIATRICS
9/17/2012
4/1/2011
4/1/2016 PEDIATRICS
2/4/2011
7/1/2011
6/1/2012
2/4/2016 PEDIATRICS
Secondary Specialty
(Self-Designated)
NEONATOLOGY
Practice City
EASTLAND
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
NEONATALPERINATAL
MEDICINE
HOSPITALIST
6/4/2010 None
7/11/2011 None
8/27/2009 None
N/A
N/A
N/A
6/4/2010 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
TX
ACTIVE
1/8/2013 None
N/A
AUSTIN
TX
ACTIVE
ACTIVE
8/26/2013 None
6/20/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/8/2011 None
8/5/2010 None
1/27/2011 None
N/A
N/A
N/A
2/5/2010 None
N/A
8/27/2010 None
8/31/2009 None
11/25/2009 None
N/A
N/A
N/A
1/18/2011 None
N/A
10/29/2010 None
N/A
8/24/2010 None
N/A
12/16/2012 None
4/6/2011 None
N/A
N/A
2/4/2011 None
N/A
7/6/2011 None
6/27/2012 None
N/A
N/A
PEDIATRICS
ARLINGTON
TX
PEDIATRIC
NEPHROLOGY
SAN ANTONIO TX
HOUSTON
TX
NEONATALPERINATAL
MEDICINE
ACTIVE
DELINQUEN
T-NON
PAYMENT
ACTIVE
LICENSE
ISSUED
BROWNSVILL
E
TX
Page 257 of 301
Disciplinary
Status Date
HOUSTON
PEDIATRICS,
CARDIOLOGY
7/1/2016 PEDIATRICS
6/1/2017 PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N1943
VISWAM, GITA , MD
12/12/2008 12/12/2013 PEDIATRICS
P5903
VO, ANNE CHAU, DO
3/15/2013
N6759
N1211
VUELVAS, JUAN, MD
VYAS, AMY M., MD
6/4/2010
8/29/2008
6/4/2015 PEDIATRICS
K9450
P1431
WACKER, NIKKI ULLRICH, MD
WAKIM, NADINE , MD
8/1/2013
11/4/2011
8/1/2018 PEDIATRICS
P0514
P5491
WALDROP, STEPHANIE WILLETTE,
MD
WALSTON, SHAYE LYSETTE, DO
7/15/2011
2/1/2013
2/1/2018 PEDIATRICS
6/4/2010
7/1/2013
6/4/2015 PEDIATRICS
7/1/2018 PEDIATRICS
P1835
WAW, KRISTEN DEANN, MD
WELCH, BRANDY NICOLE, MD
WENNER, MELINDA ELIZABETH,
DO
1/2/2012
1/2/2017 PEDIATRICS
N7029
WHITMAN, CHRISTINE MINAH, MD
7/1/2010
7/1/2015 PEDIATRICS
N6102
WINTERMEYER, KEITH A, MD
WOLF, MATTHIAS TILMANN
FLORIAN, MD
4/9/2010
4/9/2015 PEDIATRICS
N6763
P7227
N7190
N6107
7/15/2010
4/9/2010
4/9/2015 PEDIATRICS
N3394
WOODS, RASHIDA HALIMA, MD
WRIGHT-BOWERS, DEBRA
SHANELLE, MD
5/29/2009
P7053
YOUSAF, SHAGUFTA, MD
6/14/2013
P6118
P0326
YUST, ELIZABETH MARIE, MD
ZEAGER, MICHELLE ANN, DO
ZERTUCHE SANCHEZ, AURORA
DENISE, MD
ZIBDEH-LOUGH, HANA ISAM, DO
4/1/2013
7/1/2011
4/1/2018 PEDIATRICS
7/1/2016 PEDIATRICS
8/27/2010
7/15/2013
N7600
P7373
Secondary Specialty
(Self-Designated)
Practice City
PUBLIC
HEALTH/PREVENTIVE
MEDICINE
(GENERAL)
PLANO
PEDIATRIC
EMERGENCY
MEDICINE (EM)
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
HOUSTON
FLOWER
MOUND
DALLAS
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
TX
TX
ACTIVE
ACTIVE
HOUSTON
TX
MCKINNEY
TX
FORT HOOD
PEDIATRIC
NEPHROLOGY
DALLAS
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
TX
Page 258 of 301
HOUSTON
HARLINGEN
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Disciplinary
Status Date
2/9/2009 None
N/A
3/15/2013 None
N/A
6/4/2010 None
9/29/2008 None
N/A
N/A
8/6/2013 None
11/21/2011 None
N/A
N/A
7/15/2011 None
2/11/2013 None
N/A
N/A
6/4/2010 None
7/2/2013 None
N/A
N/A
1/5/2012 None
N/A
7/1/2010 None
N/A
4/9/2010 None
N/A
TX
ACTIVE
7/27/2010 None
N/A
TX
ACTIVE
4/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/13/2009 None
N/A
6/14/2013 None
N/A
ACTIVE
ACTIVE
4/2/2013 None
7/8/2011 None
N/A
N/A
ACTIVE
ACTIVE
9/2/2010 None
7/25/2013 None
N/A
N/A
WAXAHACHIE TX
PEDIATRICS
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
PEDIATRICS,
ALLERGY &
N5786
KOLSKI, GERALD BRIAN, MD
4/9/2010
4/9/2015 IMMUNOLOGY
PEDIATRICS,
ALLERGY &
P5116
ORANGE, JORDAN SCOTT, MD
12/17/2012 12/17/2017 IMMUNOLOGY
PEDIATRICS,
ALLERGY &
P5116
12/17/2012 12/17/2017 IMMUNOLOGY
PEDIATRICS,
ALLERGY &
P5116
12/17/2012 12/17/2017 IMMUNOLOGY
PEDIATRICS,
ALLERGY &
N7367
VARSHNEY, POOJA , MD
8/2/2010
8/2/2015 IMMUNOLOGY
PEDIATRICS,
P5582
ADEBO, DILACHEW ACHIKO, MD
3/1/2013
3/1/2018 CARDIOLOGY
ALMEIDA-JONES, MYRIAM
PEDIATRICS,
P6125
EVELINE, MD
4/12/2013
PEDIATRICS,
N8605
ANGTUACO, SYLVIA S O, MD
2/4/2011
2/4/2016 CARDIOLOGY
PEDIATRICS,
P7066
BANSAL, MANISH, MD
7/1/2013
7/1/2018 CARDIOLOGY
PEDIATRICS,
P4419
BECKER, JUDITH ANNE, MD
9/17/2012
PEDIATRICS,
N8488
BORNEMEIER, RENEE ADAMS, MD
1/18/2011
PEDIATRICS,
N9817
BRENNEN, DAVID MICHAEL, MD
6/3/2011
6/3/2016 CARDIOLOGY
PEDIATRICS,
G4225
BRICKER, JOHN TIMOTHY, MD
11/15/2011 11/15/2016 CARDIOLOGY
H7932
N7062
BUBOLZ, BETH , MD
BURKHOLDER, HENRY LEROY IV,
MD
P7402
BUTCHKO, GARY JON, MD
P4637
CHAN, SOI-YU, MD
PEDIATRICS,
2/5/2015 CARDIOLOGY
PEDIATRICS,
7/15/2010
PEDIATRICS,
8/1/2013
8/1/2018 CARDIOLOGY
PEDIATRICS,
10/15/2012 10/15/2017 CARDIOLOGY
2/5/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ALLERGY AND
IMMUNOLOGY
LICENSE
ISSUED
4/9/2010 None
N/A
ALLERGY AND
IMMUNOLOGY
LICENSE
ISSUED
12/17/2012 None
N/A
ALLERGY AND
IMMUNOLOGY
HOUSTON
TX
ACTIVE
1/22/2013 None
N/A
ALLERGY AND
IMMUNOLOGY
HOUSTON
TX
ACTIVE
1/22/2013 None
N/A
ALLERGY AND
IMMUNOLOGY
AUSTIN
TX
ACTIVE
9/8/2010 None
N/A
PHILADELPHIA PA
ACTIVE
3/5/2013 None
N/A
NEW YORK
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/25/2013 None
N/A
2/4/2011 None
N/A
7/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
10/24/2012 None
N/A
1/18/2011 None
N/A
6/14/2011 None
N/A
11/22/2011 None
N/A
2/5/2010 None
N/A
7/15/2010 None
N/A
NY
PEDIATRICS
HOUSTON
PEDIATRICS
PEDIATRIC EMER
MED (PEDS)
TX
SAN ANTONIO TX
ACTIVE
HOUSTON
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
TX
LOS ANGELES CA
PEDIATRICS
CORPUS
CHRISTI
TX
ACTIVE
8/5/2013 None
N/A
PEDIATRICS
TEMPLE
TX
ACTIVE
10/18/2012 None
N/A
Page 259 of 301
License
Number
Physician Name
N6842
CLAY, MARK ANTHONY, MD
N0715
CURZON, CHRISTOPHER LEE, DO
P7756
DARLING, MATTHEW JAMES, DO
P2110
P5622
DELAUZ, CARIDAD MAYLIN, MD
ENGELHARDT, KEVIN PATRICK,
MD
P6393
GATLIN, SCOTT, MD
P6619
GLASOW, CHRISTINE ANNE, MD
N9213
GOLDSTEIN, BRIAN SETH, MD
P2657
GOSPIN, TAL ALON, MD
N1662
GUPTA, JYOTI, MD
P0221
GUPTA, UMANG, MD
N0847
IMUNDO, JASON RYAN, MD
N8110
JEEWA, AAMIR, MD
N3110
KANE, COLIN EDWARD , MD
N9726
KUO, JAMES ANDREW, MD
P0753
LAWRENCE, EMILY JEAN, DO
N7451
LIOU, AIMEE , MD
P7673
MIYAKE, CHRISTINA, MD
N5944
PHILLIPS, BRANDON LANE, MD
N3256
QURESHI, MUHAMMAD ASIF, MD
edicaid
edicaid
End Date
Designated)
PEDIATRICS,
7/1/2010
7/1/2015 CARDIOLOGY
PEDIATRICS,
8/29/2008
PEDIATRICS,
8/30/2013
PEDIATRICS,
2/10/2012
PEDIATRICS,
3/1/2013
3/1/2018 CARDIOLOGY
PEDIATRICS,
5/1/2013
5/1/2018 CARDIOLOGY
PEDIATRICS,
5/15/2013
PEDIATRICS,
4/1/2011
4/1/2016 CARDIOLOGY
PEDIATRICS,
4/2/2012
4/2/2017 CARDIOLOGY
PEDIATRICS,
12/12/2008 12/12/2013 CARDIOLOGY
PEDIATRICS,
7/1/2011
7/1/2016 CARDIOLOGY
PEDIATRICS,
8/29/2008
PEDIATRICS,
11/15/2010 11/15/2015 CARDIOLOGY
PEDIATRICS,
5/29/2009
PEDIATRICS,
5/16/2011
PEDIATRICS,
8/15/2011
PEDIATRICS,
8/16/2010
PEDIATRICS,
8/15/2013
PEDIATRICS,
4/9/2010
4/9/2015 CARDIOLOGY
PEDIATRICS,
5/29/2009
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
INTERNAL MEDICINE
PEDIATRICS,
CARDIOLOGY
SAN ANTONIO TX
URGENT CARE
FT SAM
MEDICINE
HOUSTON
TX
PEDIATRICS
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/1/2010 None
N/A
ACTIVE
9/5/2008 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/9/2013 None
N/A
2/10/2012 None
N/A
3/1/2013 None
N/A
5/6/2013 None
N/A
5/23/2013 None
N/A
4/1/2011 None
N/A
PEDIATRICS
DALLAS
TX
ACTIVE
PEDIATRICS
ALTANTA
GA
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
4/9/2012 None
N/A
TX
ACTIVE
12/30/2008 None
N/A
PEDIATRICS
MCALLEN
CORPUS
CHRISTI
TX
ACTIVE
7/6/2011 None
N/A
PEDIATRICS
DALLAS
TX
ACTIVE
9/8/2008 None
N/A
HOUSTON
TX
ACTIVE
1/10/2011 None
N/A
DALLAS
TX
ACTIVE
6/4/2009 None
N/A
FORT WORTH TX
ACTIVE
5/24/2011 None
N/A
HOUSTON
TX
ACTIVE
8/30/2011 None
N/A
PEDIATRICS
CARDIOVASCULAR
DISEASES
HOUSTON
TX
ACTIVE
9/8/2010 None
N/A
ELECTROPHYSIOLO
GY
HOUSTON
TX
ACTIVE
8/23/2013 None
N/A
PEDIATRICS
SAN ANTONIO TX
ACTIVE
4/14/2010 None
N/A
PEDIATRICS
AMARILLO
ACTIVE
6/11/2009 None
N/A
Page 260 of 301
TX
License
Number
H3519
Physician Name
P7563
SCHMER, VERONICA R E, MD
SCHUMAN MCCOY, JEANNINE
MICHELLE, MD
P3581
SEERY, THOMAS J, MD
N8348
SHAPIRO, ALLAN JAMES, MD
P7708
SIMS, AMY ELIZABETH, MD
N9304
SOPONTAMMARAK, SOMKIAT, MD
P4538
ALFONSO, JOHN DENNIS
CAYANAN, MD
P2571
ALLAM, ANAND M, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRICS,
3/1/2012
3/1/2017 CARDIOLOGY
PEDIATRICS,
8/1/2013
8/1/2018 CARDIOLOGY
PEDIATRICS
PEDIATRICS,
6/8/2012
6/8/2017 CARDIOLOGY
PEDIATRICS,
12/15/2010 12/15/2015 CARDIOLOGY
PEDIATRICS
PEDIATRICS,
8/15/2013
PEDIATRICS,
4/1/2011
4/1/2016 CARDIOLOGY
UNDERSEA AND
PHYSICAL MED. &
HYPERBARIC MED
10/1/2012
10/1/2017 REHABILITATION
(PREV MED)
PHYSICAL MED. &
SPINAL CORD
4/2/2012
INJURY MEDICINE
N2374
ALVAREZ, AIXA LYMARIE , MD
4/3/2009
4/3/2014
N9500
ANDERS, DANDREA MICHELLE, MD
5/2/2011
5/2/2016
N4292
BERLINER, JEFFREY CRAIG, DO
11/6/2009
11/6/2014
P7077
BRAR, ANUREET KAUR, DO
7/1/2013
7/1/2018
P1729
BRENDEL, WILLIAM BRIAN JR, MD
1/2/2012
1/2/2017
N7608
CARLOCK, JOSEPH BENJAMIN, MD
9/1/2010
P6596
CHANDLER, SETH DUNCAN, DO
5/15/2013
P4741
CHANG, VICTOR, MD
11/1/2012
P5608
CHO, DONG SIK, MD
3/1/2013
P1533
COLBERT, CHRISTLE DENISE, MD
12/1/2011
9/1/2015
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
4/9/2012 None
N/A
AUSTIN
TX
ACTIVE
8/12/2013 None
N/A
HOUSTON
TX
ACTIVE
6/25/2012 None
N/A
SPRINGFIELD MO
ACTIVE
12/22/2010 None
N/A
HOUSTON
TX
ACTIVE
8/16/2013 None
N/A
LUBBOCK
TX
ACTIVE
4/6/2011 None
N/A
SAN ANTONIO TX
ACTIVE
10/8/2012 None
N/A
HOUSTON
TX
ACTIVE
4/4/2012 None
N/A
SPORTS MEDICINE PHYSICAL MEDICINE
& REHABILITATION
SAN ANTONIO TX
ACTIVE
5/11/2009 None
N/A
SPINAL CORD
INJURY MEDICINE
HOUSTON
TX
ACTIVE
6/13/2011 None
N/A
HOUSTON
TX
ACTIVE
11/20/2009 None
N/A
ACTIVE
8/7/2013 None
N/A
ACTIVE
2/21/2012 None
N/A
ACTIVE
11/1/2010 None
N/A
ACTIVE
7/4/2013 None
N/A
TX
ACTIVE
12/13/2012 None
N/A
TX
ACTIVE
3/8/2013 None
N/A
SAN ANTONIO TX
ACTIVE
12/5/2011 None
N/A
SPINAL CORD
INJURY MEDICINE
OSTEO
MANIPULATIVE
MEDICINE
HOUSTON
ELECTRODIAGNOSTI
C MEDICINE
MARSHALL
Page 261 of 301
License
Number
Physician Name
P6606
DITOMMASO, CRAIG , MD
P0039
DO, KIM DAN, MD
N6265
DOROFTEI, OLGA, MD
P1177
DURAND SANCHEZ, ANA V, MD
N6275
EDWARDS, IVAN , DO
P1867
GILLALA, VARSHA REDDY, DO
H5448
GRAY, LAURA ANN, MD
edicaid
edicaid
End Date
Designated)
PHYSICAL MED. &
5/15/2013
PHYSICAL MED. &
6/15/2011
PHYSICAL MED. &
6/4/2010
PHYSICAL MED. &
10/17/2011 10/17/2016 REHABILITATION
6/4/2010
1/17/2012
11/30/2012
P3633
HAMILTON, ALAN SCOTT, MD
6/15/2012
P1552
JAMES, MICHAEL EUGENE, MD
12/1/2011
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
N5134
JONES, WILLIAM MOSI, MD
2/5/2010
2/5/2015
N9717
JORGENSEN, JASON , DO
5/16/2011
5/16/2016
N6896
JOSEPH, PRATHAP JACOB, MD
7/1/2010
7/1/2015
N4513
KEAIS, JANET RENE', DO
11/6/2009
11/6/2014
P5827
KHALIL, MOUNIR FAWZI, MD
3/15/2013
3/15/2018
P2880
N9463
N9382
KIEU, PHONG, MD
LAKSHMINARASIMHIAH, PRASAD,
MD
LAL, SUNDEEP S, MD
4/13/2012
4/15/2011
4/8/2011
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
PAIN
MANAGEMENT/REHA
B MED
TUPELO
MS
SPINE AND SPORTS
MEDICINE
& REHABILITATION
TYLER
TX
TX
N/A
6/20/2011 None
N/A
6/4/2010 None
N/A
10/17/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
1/27/2012 None
N/A
ACTIVE
12/3/2012 None
N/A
ACTIVE
LICENSE
ISSUED
6/20/2012 None
N/A
12/1/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
5/19/2011 None
N/A
ACTIVE
7/12/2010 None
N/A
11/12/2009 None
N/A
3/15/2013 None
N/A
4/13/2012 None
N/A
4/21/2011 None
SEE
PREVIOUS
4/8/2011 ORDER
N/A
SPINE MEDICINE
ACTIVE
LICENSE
ISSUED
& REHABILITATION
LICENSE
ISSUED
SAN ANTONIO TX
PAIN
MANAGEMENT/REHA
B MED
Page 262 of 301
Disciplinary
Status Date
6/3/2013 None
LICENSE
ISSUED
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
4/11/2011
License
Number
N3129
Physician Name
LAMIA, TATIANA , MD
edicaid
edicaid
End Date
Designated)
PHYSICAL MED. &
5/29/2009
N1735
LIEN, ELLISIV, MD
N5816
LLANOS, RAUL MAURICIO, DO
4/9/2010
4/9/2015
N5823
MAGAT, ELAINE MAGDARAOG, MD
4/9/2010
4/9/2015
P5675
MALIK, ATIF BABAR, MD
3/1/2013
3/1/2018
P3386
MANASA, POONAM MEHTA, MD
6/1/2012
6/1/2017
N7457
MANZI, SUZANNE MARIE, MD
N7639
MCCAIN, KARWIN LAJUAN, MD
P0097
N8820
P1476
MEHTA, ANKUR D, DO
MELENDEZ, MARIA MERCEDES,
MD
MIRASOL, ALAN P, MD
12/12/2008 12/12/2013
8/16/2010
9/1/2010
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
2/15/2011
PHYSICAL MED. &
11/15/2011 11/15/2016 REHABILITATION
6/15/2011
N9607
MOORE, MELITA NACHETTE', MD
5/2/2011
5/2/2016
N6514
MUKKAMALA, SRIDEVI, MD
6/4/2010
6/4/2015
P2900
N8695
N3942
P1571
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
MUNSHI, SATVIK BHARGAV, MD
NEMUNAITIS, GREGORY ALLAN,
MD
4/13/2012
4/13/2017
2/4/2011
2/4/2016
NGUYEN, CAYLI TAM PHUONG, DO
NUNEZ, RIGOBERTO NICHOLAS,
MD
8/21/2009
8/21/2014
12/1/2011
12/1/2016
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
REHABILITATION
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
N/A
12/17/2008 None
N/A
4/9/2010 None
N/A
ACTIVE
4/27/2010 None
N/A
ACTIVE
4/3/2013 None
N/A
ACTIVE
6/8/2012 None
N/A
MI
ACTIVE
9/9/2010 None
N/A
SAN ANTONIO TX
ACTIVE
9/27/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/20/2011 None
N/A
2/15/2011 None
N/A
11/17/2011 None
N/A
ACTIVE
LICENSE
ISSUED
6/1/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/23/2012 None
N/A
2/4/2011 None
N/A
ACTIVE
9/14/2009 None
N/A
ACTIVE
1/16/2012 None
N/A
HOUSTON
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
TX
PAIN MANAGEMENT
PAIN
MANAGEMENT/REHA
B MED
LANSING
PAIN
MANAGEMENT/REHA
B MED
PALLIATIVE
MEDICINE
BEVERLY
HILLS
CA
& REHABILITATION
SPINAL CORD
INJURY MEDICINE
PAIN MEDICINE
SPINAL CORD
INJURY MEDICINE
NEW
ORLEANS
MAYWOOD
LA
IL
SAN ANTONIO TX
Page 263 of 301
Disciplinary
Status Date
6/5/2009 None
& REHABILITATION
TYLER
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
PHYSICAL MED. &
7/15/2011
PHYSICAL MED. &
5/1/2013
PHYSICAL MED. &
6/4/2010
PHYSICAL MED. &
6/8/2012
PHYSICAL MED. &
6/1/2012
PHYSICAL MED. &
6/14/2013
PHYSICAL MED. &
9/1/2010
P0457
OCHANI, POONAM, MD
P6487
ONI, MARGARET BOSEDE, MD
N6552
ORENGO, LUIS ANTONIO, MD
P3560
OTHEE, MANDEEP SINGH, MD
P3405
PANDIT, SINDHU, MD
P7017
PARKS, THOMAS JOSEPH, MD
N7650
PENA, ENRIQUE BOSCO, MD
N9933
PITINO, LISA MARIE MORAWSKI,
DO
6/3/2011
P7540
PLOSKANYCH, TARAS , MD
8/1/2013
N9116
QUINONES PAGAN, VIRMARIE, MD
3/15/2011
P7839
RAMOS, JESUS MIGUEL, MD
8/30/2013
P7842
RILEY, CYNTHIA R, MD
8/30/2013
P6717
SAMBASIVAN, AJAI , MD
5/15/2013
P1021
SEZGINIS, ARAL , MD
9/15/2011
P6525
SIKKA, SEEMA, MD
5/1/2013
N6676
SPINELLI, JAMES P JR, DO
6/4/2010
N6707
TATE, TEMEKA LOTT, MD
6/4/2010
N6064
TENNISON, JEGY MARY, MD
4/9/2010
N7975
THORLEY, RODNEY R, MD
10/15/2010
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
8/26/2011 None
N/A
ACTIVE
LICENSE
ISSUED
5/13/2013 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
6/18/2012 None
N/A
HOUSTON
ELECTRODIAGNOSTI
C MEDICINE
ADDISON
TX
ACTIVE
6/13/2012 None
N/A
TX
ACTIVE
6/20/2013 None
N/A
SPINE MEDICINE
AUSTIN
PAIN
MANAGEMENT/REHA
B MED
TX
ACTIVE
10/5/2010 None
N/A
LICENSE
ISSUED
6/3/2011 None
N/A
ACTIVE
8/5/2013 None
N/A
3/15/2011 None
N/A
9/4/2013 None
N/A
8/30/2013 None
N/A
5/15/2013 None
N/A
11/30/2011 None
N/A
5/8/2013 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
4/30/2010 None
N/A
ACTIVE
10/21/2010 None
N/A
PAIN MEDICINE
ODESSA
TEMPLE
TX
PEDIATRIC
REHABILITATION
MEDICINE
LICENSE
ISSUED
AUSTIN
HOUSTON
PAIN
MANAGEMENT/REHA
B MED
SPINAL CORD
INJURY MEDICINE
CLEVELAND
TX
TX
ACTIVE
OH
PAIN MEDICINE
CHESTERFIEL
D
MO
Page 264 of 301
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
Practice City
PHYSICAL MED. &
2/15/2011
PHYSICAL MED. &
5/15/2013
GERIATRICS
PAIN
PHYSICAL MED. &
MANAGEMENT/REHA
11/4/2011
B MED
AUSTIN
P6746
Physician Name
TUAMOKUMO, TIMI SENA-KOLA,
MD
WAKEHAM, CATHERINE
DAVENPORT POLLOCK, MD
P1432
WALLACE, PHILIP COLEMAN, MD
H0953
WINDSOR, ROBERT E JR, MD
P7369
P4729
WINN, WILLIAM BYRON, DO
YANG, JENNIFER MARIE JUINIO,
MD
P1154
YOUNG, CARLA L, MD
N5508
ZHANG, LING , MD
P6304
ZHANG, YUANHUI , MD
4/12/2013
N8482
ARMIJO, BRYAN S, MD
1/18/2011
P2194
BEIDLER, STEPHANIE KATHRYN,
MD
3/1/2012
P2596
BLAKKOLB, CHRISTI LYNN, MD
4/2/2012
M6054
BOEHMLER, JAMES HERBERT IV,
MD
P1169
CAMP, STEVEN MARTIN, MD
P2213
CHEN, JOYCE CHI-YI, MD
N8864
PHYSICAL MED. &
PHYSICAL MED. &
7/15/2013
PHYSICAL MED. &
10/15/2012 10/15/2017 REHABILITATION
8/26/2011
PAIN MANAGEMENT
10/3/2011
SPINAL CORD
INJURY MEDICINE
PAIN
MANAGEMENT/REHA
B MED
ARLINGTON
2/5/2010
8/15/2013
10/17/2011
3/1/2012
PHYSICAL MED. &
PHYSICAL MED. &
PHYSICAL MED. &
PLASTIC &
RECONSTRUCTIVE
1/18/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
3/1/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/2/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
8/15/2018 SURGERY
PLASTIC &
RECONSTRUCTIVE
10/17/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
3/1/2017 SURGERY
MARIETTA
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
GA
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/15/2011 None
N/A
ACTIVE
5/28/2013 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
12/1/2011 None
N/A
8/26/2011 None
N/A
7/15/2013 None
N/A
ACTIVE
10/23/2012 None
N/A
ACTIVE
LICENSE
ISSUED
10/12/2011 None
N/A
2/5/2010 None
N/A
AMARILLO
TX
ACTIVE
4/18/2013 None
N/A
DALLAS
TX
ACTIVE
1/24/2011 None
N/A
CHAPEL HILL
NC
ACTIVE
3/13/2012 None
N/A
ACTIVE
4/6/2012 None
N/A
PLASTIC SURGERY
COLUMBUS
OH
ACTIVE
8/19/2013 None
N/A
PLASTIC SURGERY
FORT WORTH TX
ACTIVE
11/1/2011 None
N/A
LUBBOCK
ACTIVE
3/13/2012 None
N/A
Page 265 of 301
TX
License
Number
Physician Name
P0968
COLE, ERIC LOWRY, MD
P5952
CRAIG, ELIZABETH STIRLING, MD
P2629
DAS, DIPAN , MD
P3315
EGELAND, BRENT M, MD
P6614
FARKAS, JORDAN PHILLIP, MD
P6387
FISHER, CHRISTINE, MD
P2866
HADDOCK, NICHOLAS TILL, MD
P2664
HASSID, VICTOR JOSEPH, MD
N5726
HERMANN, BRUCE FREDERICK,
MD
N6386
JARIAL, RAVINDER, DO
N7552
KANE, ALEX A, MD
N8801
KAWAMURA, DAVID HIROSHI, MD
N5790
KOZLOW, JEFFREY HALL, MD
edicaid
edicaid
End Date
Designated)
PLASTIC &
RECONSTRUCTIVE
9/15/2011
9/15/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/1/2013
4/1/2018 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/2/2012
4/2/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
6/1/2012
6/1/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
5/15/2013
5/15/2018 SURGERY
PLASTIC &
RECONSTRUCTIVE
5/1/2013
5/1/2018 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/13/2012
4/13/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/2/2012
4/2/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/9/2010
4/9/2015 SURGERY
PLASTIC &
RECONSTRUCTIVE
6/4/2010
6/4/2015 SURGERY
PLASTIC &
RECONSTRUCTIVE
8/27/2010
8/27/2015 SURGERY
PLASTIC &
RECONSTRUCTIVE
2/15/2011
2/15/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/9/2010
4/9/2015 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
OTORHINOLARYNGO
LOGY
GALVESTON
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
9/28/2011 None
N/A
ACTIVE
4/3/2013 None
N/A
HAND SURGERY PLASTIC SURGERY
ACTIVE
4/9/2012 None
N/A
LICENSE
ISSUED
6/1/2012 None
N/A
ACTIVE
6/20/2013 None
N/A
COSMETIC SURGERY AUSTIN
TX
ACTIVE
6/3/2013 None
N/A
HAND SURGERY
TX
ACTIVE
4/23/2012 None
N/A
TX
ACTIVE
4/9/2012 None
N/A
TX
ACTIVE
4/28/2010 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
ACTIVE
9/8/2010 None
N/A
LICENSE
ISSUED
2/15/2011 None
N/A
LICENSE
ISSUED
4/9/2010 None
N/A
DALLAS
DENTON
GENERAL SURGERY
DALLAS
Page 266 of 301
TX
License
Number
Physician Name
P3374
KURKJIAN, THEODORUS
JONATHAN, MD
N8806
KWON, ROBERT KANG, MD
P3185
LAI, ERIC CHRISTIAN, MD
N8535
LE, NAM HOAI, MD
P3026
LEE, ANHTUYET THI BUI, MD
N9597
MARRERO, DERIK IVAN, MD
N4589
MILLER, QUINTESSA, MD
N8956
MOHAN, PRADEEP SHARMA, MD
N7950
MONTILLA, RICHARD VINCENT
DELEON, MD
N9390
MORALES, ROLANDO JR, MD
N7952
NAJERA, ROBERT MATTHEW, MD
N8437
PALLADINO, HUMBERTO , MD
P7331
POTTER, ELISABETH HOUSE, MD
edicaid
edicaid
End Date
Designated)
PLASTIC &
RECONSTRUCTIVE
6/1/2012
6/1/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
2/15/2011
2/15/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
5/15/2012
5/15/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
1/18/2011
1/18/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
5/1/2012
5/1/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
5/2/2011
5/2/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
11/6/2009
11/6/2014 SURGERY
PLASTIC &
RECONSTRUCTIVE
3/1/2011
3/1/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
10/15/2010 10/15/2015 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/8/2011
4/8/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
10/15/2010 10/15/2015 SURGERY
PLASTIC &
RECONSTRUCTIVE
1/3/2011
1/3/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
7/15/2013
7/15/2018 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
HAND SURGERY
HAND SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
6/25/2012 None
N/A
LICENSE
ISSUED
2/15/2011 None
N/A
LICENSE
ISSUED
5/15/2012 None
N/A
ACTIVE
1/26/2011 None
N/A
NEW
ORLEANS
LA
ACTIVE
5/7/2012 None
N/A
DALLAS
TX
ACTIVE
6/15/2011 None
N/A
GENERAL SURGERY SAN ANTONIO TX
ACTIVE
11/16/2009 None
N/A
ACTIVE
3/7/2011 None
N/A
10/15/2010 None
N/A
ACTIVE
4/15/2011 None
N/A
ACTIVE
10/20/2010 None
N/A
ABILENE
TX
LICENSE
ISSUED
GALVESTON
TX
PLASTIC SURGERY
EL PASO
TX
ACTIVE
2/9/2011 None
N/A
PLASTIC SURGERY
AUSTIN
TX
ACTIVE
7/24/2013 None
N/A
Page 267 of 301
License
Number
Physician Name
P0863
POWERS, KAREN LYNNE, MD
N5973
RINARD, JEREMY RONALD, MD
P1922
ROOSTAEIAN, JASON, MD
P6908
SABA, SALIM CHARLES, MD
P2164
SANDERSON, DREW , MD
N6725
TROVATO, MATTHEW JOHN, MD
N4807
TSAI, TSUNG-LIN ROGER, MD
P0526
N7673
ZHANG, ANDREW YUAN, MD
AMIRLAK, BARDIA, MD
AUGENSTEIN, ADAM CHRISTIAN,
MD
P2093
edicaid
edicaid
End Date
Designated)
PLASTIC &
RECONSTRUCTIVE
8/26/2011
8/26/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/9/2010
4/9/2015 SURGERY
PLASTIC &
RECONSTRUCTIVE
1/17/2012
1/17/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
6/3/2013
6/3/2018 SURGERY
PLASTIC &
RECONSTRUCTIVE
2/10/2012
2/10/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
6/4/2010
6/4/2015 SURGERY
PLASTIC &
RECONSTRUCTIVE
11/6/2009
11/6/2014 SURGERY
PLASTIC &
RECONSTRUCTIVE
7/15/2011
7/15/2016 SURGERY
9/15/2010
2/10/2012
Secondary Specialty
(Self-Designated)
Practice City
TEMPLE
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
LICENSE
ISSUED
8/26/2011 None
N/A
LICENSE
ISSUED
4/9/2010 None
N/A
LICENSE
ISSUED
1/17/2012 None
N/A
TX
ACTIVE
6/4/2013 None
N/A
OTOLARYNGOLOGY
PLASTIC SURGERY
WITHIN THE HEAD
AND NECK
NE
ACTIVE
2/14/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
1/11/2010 None
N/A
ACTIVE
ACTIVE
7/20/2011 None
10/4/2010 None
N/A
N/A
ACTIVE
2/14/2012 None
N/A
OMAHA
LICENSE
ISSUED
PLASTIC SURGERY
HAND SURGERY SURGERY
HAND SURGERY
HEAD AND NECK
SURGERY
GALVESTON
DALLAS
PORT
ARTHUR
HOUSTON
TX
TX
P4926
P5605
BAYAT, NEYSAN, MD
CABILING, DAVID SHANNON, MD
11/30/2012 11/30/2017 PLASTIC SURGERY
3/1/2013
HAND SURGERY
TX
TX
ACTIVE
ACTIVE
12/7/2012 None
3/13/2013 None
N/A
N/A
N4334
P4853
P1857
CHAN, RODNEY K, MD
CHIKE-OBI, CHUMA , MD
DAVIS, MICHAEL ROBERT, MD
11/6/2009
11/15/2012 11/15/2017 PLASTIC SURGERY
1/17/2012
ACTIVE
ACTIVE
ACTIVE
11/18/2009 None
11/28/2012 None
1/23/2012 None
N/A
N/A
N/A
N2513
N8931
P4473
GAGE, EARL ANTHONY , MD
HUBBARD, BRADLEY ALAN, MD
KITTINGER, BENJAMIN JOSEPH,
MD
P5223
PEKAREV, MAXIM, MD
4/3/2009
3/1/2011
9/17/2012
1/4/2013
SAN ANTONIO TX
CRANIOFACIAL
SURGERY
DALLAS
TX
ACTIVE
ACTIVE
4/14/2009 None
3/14/2011 None
N/A
N/A
EMERGENCY
MEDICINE
TEMPLE
TX
ACTIVE
9/19/2012 None
N/A
ACTIVE
1/9/2013 None
N/A
GENERAL SURGERY
Page 268 of 301
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P3587
SOLOMON, MATTHIAS, MD
P1023
P6113
N6128
SOMAYAZULA, RAVI KIRAN, DO
WU, DANIEL , MD
ABDUL, OLUMUYIWA ADEGBENGA,
MD
ADEBOGUN, OLADELE ADEPITAN,
MD
P6941
N7669
AGBORO-IDAHOSA, EJIRO VIVIAN,
MD
ALAM, AKHTAR, MD
6/14/2013
9/15/2010
P3605
AMIN, TANIA , MD
6/15/2012
N2378
N5533
ANDERSON, CHRISTOPHER TODD,
MD
ANDERSON, JAHI KASHKA, MD
4/3/2009
4/9/2010
4/3/2014 PSYCHIATRY
4/9/2015 PSYCHIATRY
P1444
ANIAKUDO, MAUREEN , MD
11/15/2011 11/15/2016 PSYCHIATRY
P5024
ANITUBE, MAXIMUS
NWAKALUNNA, MD
12/17/2012 12/17/2017 PSYCHIATRY
P5024
ANITUBE, MAXIMUS
NWAKALUNNA, MD
12/17/2012 12/17/2017 PSYCHIATRY
P5024
ANITUBE, MAXIMUS
NWAKALUNNA, MD
12/17/2012 12/17/2017 PSYCHIATRY
P6327
ARENIVAR, LEROY , MD
5/1/2013
5/1/2018 PSYCHIATRY
P5329
AYENI, OLAYINKA MODUPE, MD
2/1/2013
2/1/2018 PSYCHIATRY
P6133
AYERS, GAYLE YVONNE, DO
4/12/2013
P1954
P2949
AZIZ, BUSHRA, MD
6/8/2012
9/15/2011
4/1/2013
2/1/2012
2/1/2017 PSYCHIATRY
6/4/2010
6/4/2015 PSYCHIATRY
5/1/2012
5/1/2017 PSYCHIATRY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
GENERAL SURGERY DULUTH
MN
ACTIVE
6/20/2012 None
N/A
GENERAL SURGERY SUGARLAND
TEMPLE
TX
TX
ACTIVE
ACTIVE
9/22/2011 None
4/8/2013 None
N/A
N/A
CLEVELAND
OH
ACTIVE
LICENSE
ISSUED
2/3/2012 None
N/A
6/4/2010 None
N/A
CHILD AND
ADOLESCENT
PSYCHIATRY
PSYCHIATRY
GERIATRIC
PSYCHIATRY
FAMILY MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
Page 269 of 301
SIOUX CITY
HOUSTON
IA
TX
ACTIVE
ACTIVE
6/25/2013 None
9/23/2010 None
N/A
N/A
DALLAS
WRIGHT
PATTERSON
AFB
CAMDEN
TX
ACTIVE
6/19/2012 None
N/A
OH
NJ
ACTIVE
ACTIVE
LICENSE
ISSUED
4/13/2009 None
4/14/2010 None
N/A
N/A
11/15/2011 None
N/A
LICENSE
ISSUED
12/17/2012 None
N/A
DALLAS
TX
ACTIVE
1/15/2013 None
N/A
DALLAS
TX
ACTIVE
1/15/2013 None
N/A
AUSTIN
TX
ACTIVE
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
6/3/2013 None
SEE
PREVIOUS
2/22/2013 ORDER
4/12/2013 None
N/A
5/10/2012 None
N/A
ACTIVE
3/1/2011
License
Number
P1845
P6781
P4632
P2591
P5338
Physician Name
BADIGER, MALLIKARJUN
PUNDLEEK, MD
BEJJANI, CARLA, MD
BELL, JACQUELINE MARIE, DO
BELZ, GLENN ROLAND, MD
BERMUDEZ POUCHARD, ELSIE
YAMILE, MD
edicaid
edicaid
End Date
Designated)
1/17/2012
6/3/2013
6/3/2018 PSYCHIATRY
10/15/2012 10/15/2017 PSYCHIATRY
4/2/2012
4/2/2017 PSYCHIATRY
2/1/2018 PSYCHIATRY
2/15/2011
5/1/2013
5/1/2018 PSYCHIATRY
P1054
BHATTI, NADEEM HANIF, MD
BROWN, AARON , DO
BROWNE-BARNUM, MICHELLE L,
MD
10/3/2011
P6147
BUI, THERESA DIEM-HANG, DO
4/12/2013
N7404
N1576
P7618
CARGILE, CHRIS SCOTT, MD
CASANOVA, EDWARD , MD
CASIANO, FELIX ANGEL JR, MD
P6956
CHAISSON-MCRAE, CLARISSA, MD
8/16/2010
12/12/2008 12/12/2013 PSYCHIATRY
8/15/2013
6/14/2013
CHELEBIAN, JACK, MD
6/4/2010
6/4/2015 PSYCHIATRY
P1979
CLARK, SHARONDA NICOLE, MD
2/1/2012
2/1/2017 PSYCHIATRY
P6960
COTTRELL, RICHARD ALLEN, DO
6/14/2013
P3137
CRISTOBAL, RONALD SALAMAT,
MD
5/15/2012
P2109
CROSS, ALISA A, MD
2/10/2012
DAMTEW, AHMED M, MD
DIAL, DEANNA LEE, DO
N8290
DIAZGRANADOS, NANCY, MD
P4438
DORTILUS, JEAN NERVA, MD
4/1/2013
4/8/2011
4/1/2018 PSYCHIATRY
4/8/2016 PSYCHIATRY
12/15/2010 12/15/2015 PSYCHIATRY
9/17/2012
GERIATRIC
PSYCHIATRY
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
6/4/2013 None
12/28/2012 None
4/27/2012 None
N/A
N/A
N/A
2/5/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/15/2011 None
5/7/2013 None
N/A
N/A
10/11/2011 None
N/A
4/12/2013 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
8/16/2010 None
12/18/2008 None
8/20/2013 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/16/2013 None
N/A
6/4/2010 None
N/A
2/1/2012 None
N/A
6/14/2013 None
N/A
ACTIVE
LICENSE
ISSUED
5/23/2012 None
N/A
2/10/2012 None
N/A
CA
TX
ACTIVE
ACTIVE
4/10/2013 None
4/13/2011 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
12/21/2010 None
N/A
ACTIVE
10/18/2012 None
N/A
HOUSTON
BEDFORD
HOUSTON
PSYCHIATRY
SAN ANTONIO TX
CHILD AND
ADOLESCENT
PSYCHIATRY
ADDICTION
PSYCHIATRY
PSYCHOANALYSIS
PHARMACOLOGY,
CLINICAL
CHILD AND
ADOLESCENT
PSYCHIATRY
Page 270 of 301
Disciplinary
Status Date
1/24/2012 None
FT. WORTH
ADDICTION
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
PSYCHIATRY
N6216
P5955
N9362
Practice City
2/1/2013
N8763
P6346
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
HOUSTON
AUSTIN
GILROY
DALLAS
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
P7270
DRIMER-KAGAN, TALY , MD
P6808
DU, YE BEVERLY, MD
P6156
N9542
N8394
P7432
P2439
P0585
N7696
P5071
DUNHAM, JEAN ANDERSON, MD
ELLENDULA, SWATI, MD
ESPADA, YAHAIRA, MD
EXUM, KELVIN, MD
FERNANDO, SANTHI, MD
GAJWANI, PRASHANT, MD
GARCIA, KEITH SIGMOND, MD
GONZALEZ-BERRIOS, NEREIDA,
MD
MD
MD
N6327
GRAVES, NANCY VICTORIA, MD
P5071
P5071
P3335
N8515
N1664
GRONSTEDT, GARY, DO
GUEVARA, ROBERT , MD
GURURAJ, BHARATH RAJ, MD
edicaid
edicaid
End Date
Designated)
7/15/2013
6/3/2013
6/3/2018 PSYCHIATRY
4/12/2013
5/2/2011
1/3/2011
8/1/2013
3/15/2012
8/1/2011
9/15/2010
4/12/2018
5/2/2016
1/3/2016
8/1/2018
3/15/2017
8/1/2016
9/15/2015
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
Secondary Specialty
(Self-Designated)
CHILD AND
ADOLESCENT
PSYCHIATRY
PSYCHIATRY
Practice City
DALLAS
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
AUSTIN
VICKSBURG
tx
MS
DALLAS
SAN ANGELO
HOUSTON
AUSTIN
TX
TX
TX
TX
12/17/2012 12/17/2017 PSYCHIATRY
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/26/2013 None
N/A
6/5/2013 None
N/A
4/12/2013
5/9/2011
1/24/2011
8/7/2013
4/17/2012
8/11/2011
9/21/2010
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
12/17/2012 None
N/A
12/17/2012 12/17/2017 PSYCHIATRY
MCALLEN
TX
ACTIVE
2/8/2013 None
N/A
12/17/2012 12/17/2017 PSYCHIATRY
MCALLEN
TX
ACTIVE
LICENSE
ISSUED
2/8/2013 None
N/A
6/4/2010 None
N/A
6/8/2012 None
1/21/2011 None
12/29/2008 None
N/A
N/A
N/A
6/4/2010
6/4/2015 PSYCHIATRY
6/1/2012
6/1/2017 PSYCHIATRY
1/18/2011
12/12/2008 12/12/2013 PSYCHIATRY
8/29/2008
12/15/2011 12/15/2016 PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
FAMILY MEDICINE
FORENSIC
PSYCHIATRY
H6263
P1648
HAGER, DAVID CHRISTOPHER, MD
HAIDER, NADEEM, MD
P6635
P6423
HILLIER, SHANNON LYNNE, DO
HUANG, HAOJIANG, MD
P1330
IBRAHIM, AALAMGEER KHAKAN,
MD
11/4/2011
N7112
ISACHIEVICI, DIANA , MD
7/15/2010
N6381
IVAN, MIHAELA CRISTINA, MD
6/4/2010
6/4/2015 PSYCHIATRY
INTERNAL MEDICINE
P1333
JILANI, MASOOD, MD
11/4/2011
INTERNAL MEDICINE
5/15/2013
5/1/2013
5/1/2018 PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
Page 271 of 301
AUSTIN
TX
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
KERRVILLE
FARGO
CORPUS
CHRISTI
LOUISVILLE
TX
ND
ACTIVE
ACTIVE
10/3/2008 None
1/3/2012 None
N/A
N/A
TX
KY
ACTIVE
ACTIVE
5/20/2013 None
7/5/2013 None
N/A
N/A
11/4/2011 None
N/A
7/15/2010 None
N/A
6/4/2010 None
N/A
11/4/2011 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
N9230
Physician Name
edicaid
edicaid
End Date
Designated)
4/1/2011
4/1/2016 PSYCHIATRY
N9235
P7478
JONES, KENYATTA MIE, MD
KALAVAPALLI, RAMPRASAD
REDDY, MD
KAZI, SEEMA, MD
4/1/2011
8/1/2013
4/1/2016 PSYCHIATRY
8/1/2018 PSYCHIATRY
P7480
KEENMON, CORINNA MARIA, MD
8/1/2013
8/1/2018 PSYCHIATRY
N5155
P1092
KHAN, MOHAMMAD SAFARAZ ALI,
MD
KHAN, MUHAMMAD FUAD, MD
2/5/2010
10/3/2011
2/5/2015 PSYCHIATRY
Secondary Specialty
(Self-Designated)
CHILD AND
ADOLESCENT
PSYCHIATRY
GERIATRIC
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TEMPLE
TX
TEMPLE
TX
ACTIVE
ACTIVE
4/6/2011 None
8/5/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/27/2013 None
N/A
DALLAS
TX
LICENSE
ISSUED
ACTIVE
2/5/2010 None
11/4/2011 None
N/A
N/A
FORT HOOD
TX
4/13/2011 None
N/A
7/1/2011 None
N/A
4/9/2010 None
5/3/2013 None
N/A
N/A
2/10/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/18/2012 None
11/13/2009 None
N/A
N/A
6/1/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/10/2013
9/1/2009
11/13/2009
5/23/2012
N9241
KHAN, SHAMIMA SULTANA, MD
4/1/2011
4/1/2016 PSYCHIATRY
P0247
KIRANE, HARSHAL DEVIDAS, MD
7/1/2011
7/1/2016 PSYCHIATRY
DALLAS
TX
F1712
P6441
4/9/2010
5/1/2013
4/9/2015 PSYCHIATRY
5/1/2018 PSYCHIATRY
BALTIMORE
TAYLOR
MD
TX
P2025
KIRKPATRICK, BRIAN, MD
KUNDLER, MARC WILLIS, MD
LAWRENCE, ANGELENE
MICHAELE, MD
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
ACTIVE
2/1/2012
2/1/2017 PSYCHIATRY
RENO
NV
ACTIVE
H8993
N4557
LEAL, DANIEL HECTOR, MD
LIN, ZUORONG, MD
6/15/2012
11/6/2009
P3380
LLUBERES, NUBIA GEYSSELL, MD
6/1/2012
6/1/2017 PSYCHIATRY
P6863
N3856
N4574
P3039
LUSINS, JOHN O III, MD
MALIK, NITIN, MD
MANNING, TESSA LEIGH, MD
MARQUEZ, AMES TADEO, MD
6/3/2013
8/21/2009
11/6/2009
5/1/2012
6/3/2018
8/21/2014
11/6/2014
5/1/2017
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
P2146
MASTERS, KEN , MD
2/10/2012
N5849
N3878
MATHEW, SANJAY JOHAN, MD
MAYHEW, AMY MARIE, MD
4/9/2010
8/21/2009
4/9/2015 PSYCHIATRY
P7671
P7510
MEMON, NAIM A, MD
MENDEZ, RUBEN , MD
8/15/2013
8/1/2013
8/1/2018 PSYCHIATRY
PSYCHIATRY
ADDICTION
PSYCHIATRY
FORENSIC
PSYCHIATRY
PSYCHIATRY
GERIATRIC
PSYCHIATRY
Page 272 of 301
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
4/1/2011 ORDER
9/27/2010
SAN ANTONIO TX
NORMAN
OK
KATY
CORPUS
CHRISTI
AUSTIN
DALLAS
HOUSTON
HOUSTON
TX
TX
TX
TX
TX
TX
ACTIVE
ACTIVE
None
None
None
None
N/A
N/A
N/A
N/A
2/10/2012 None
N/A
4/9/2010 None
12/1/2009 None
N/A
N/A
8/16/2013 None
8/9/2013 None
N/A
N/A
License
Number
Physician Name
N4604
MURTHY, SMITHA , MD
P6475
P1796
NAZARIO, MICHELLE O, MD
NGUYEN, NAM H, DO
P2328
P3401
P6232
NWOKOLO, FELIX
CHUKWUEMEKA, MD
OKUSAGA, OLAOLUWA OLOLADE,
MD
OLATUNBOSUN, SADIAT KRISTINA,
MD
OLIVIER, HOLLY , DO
ORTIZ, CHRISTIAN , MD
P4689
PASOL, ELIAS KIREL, MD
N6578
PERSON, CHERYL LYNN, MD
P4901
PERSON, MARJORIE , MD
P1573
P5441
edicaid
edicaid
End Date
Designated)
11/6/2009
5/1/2013
1/2/2012
5/1/2018 PSYCHIATRY
1/2/2017 PSYCHIATRY
12/1/2011
2/1/2013
2/1/2018 PSYCHIATRY
3/1/2012
6/1/2012
4/12/2013
3/1/2017 PSYCHIATRY
6/1/2017 PSYCHIATRY
10/15/2012 10/15/2017 PSYCHIATRY
6/4/2010
Secondary Specialty
(Self-Designated)
PSYCHOSOMATIC
MEDICINE
PEDIATRIC
PSYCHIATRY
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
11/12/2009 None
N/A
HOUSTON
GALVESTON
TX
TX
ACTIVE
ACTIVE
5/14/2013 None
1/9/2012 None
N/A
N/A
LICENSE
ISSUED
12/1/2011 None
N/A
TX
ACTIVE
2/26/2013 None
N/A
GALVESTONT TX
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
3/12/2012 None
6/6/2012 None
4/18/2013 None
N/A
N/A
N/A
HARLINGEN
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/24/2012 None
N/A
6/4/2010 None
N/A
11/15/2012 None
N/A
ACTIVE
4/23/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/22/2011 None
N/A
HOUSTON
TX
6/4/2015 PSYCHIATRY
11/15/2012 11/15/2017 PSYCHIATRY
P6242
PETTY, LEONORA KATHLEEN, MD
4/12/2013
N9114
PODOLSKI, JOSEPH EDWARD, DO
3/15/2011
P3416
N4679
N4000
N4011
POOLE, KIMBERLY MELISSA, DO
PREDANIC, ANETA, MD
PRENZLAUER, STEVEN , MD
QUINN, MELISSA DE JESUS, MD
6/1/2012
11/6/2009
8/21/2009
8/21/2009
6/1/2017
11/6/2014
8/21/2014
8/21/2014
N6591
QURESHI, SALAH UDDIN, MD
P6710
N3271
RIAZ, JAWAD, MD
RIBARNE PASZTOR, GABRIELLA ,
MD
P5000
RIZVI, SHAFQAT NA, MD
11/30/2012 11/30/2017 PSYCHIATRY
N8058
ROSS, JULIE DANIELLE, MD
10/29/2010 10/29/2015 PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
PSYCHIATRY
6/4/2010
6/4/2015 PSYCHIATRY
5/15/2013
5/29/2009
CHILD AND
ADOLESCENT
PSYCHIATRY
FORENSIC
PSYCHIATRY
FORENSIC
PSYCHIATRY
EL PASO
TEMPLE
TX
TX
ROUND ROCK TX
SAN ANTONIO TX
NEUROPSYCHIATRY
SLEEP MEDICINE
ACTIVE
ADDICTION
PSYCHIATRY
ADDICTION
PSYCHIATRY
Page 273 of 301
Disciplinary
Status Date
AUSTIN
CHILD AND
ADOLESCENT
PSYCHIATRY
PSYCHOSOMATIC
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
LICENSE
ISSUED
6/1/2012
11/11/2009
8/26/2009
8/27/2009
None
None
None
None
N/A
N/A
N/A
N/A
6/4/2010 None
N/A
5/15/2013 None
N/A
7/27/2009 None
UNDER
BOARD
11/30/2012 ORDER
N/A
10/29/2010 None
N/A
11/30/2012
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
P4506
SAEED, YAHYA, MD
9/17/2012
P7701
SANGHADIA, MUKESH, MD
8/15/2013
N8347
P2361
SCHLAGER, DAVID S, MD
SEGARS, DOUGLAS , DO
SHRESTHA, SHREE OM, MD
SINGHAL, MONIKA DESAI, MD
10/15/2012 10/15/2017 PSYCHIATRY
12/1/2010
N6671
N8149
SIVAKUMAR, ANUPAMA, MD
SNELL, TRACY , DO
6/4/2010
6/4/2015 PSYCHIATRY
11/15/2010 11/15/2015 PSYCHIATRY
N8856
P5479
SOKAL, JOSEPH O, MD
STAN, ANA DESPINA, MD
TACCIR-MACIAS, CLAUDIA
ADRIANA, MD
P6538
TRINIDAD, ANTOLIN C, MD
N2858
N8254
UNZUETA-HERNANDEZ, MARY
RICHELLE, MD
URIZAR, JUAN CARLOS, MD
N7017
VAZQUEZ, JOSE JAVIER, MD
P6109
N4197
N9149
P4836
N7980
N0795
WANG, JOSHUA J, MD
WEISMAN, HENRY W JONATHAN,
MD
WONG, HOWARD LELAND, MD
WRIGHT, ROSEMARY ELIZABETH,
DO
YAQOOB, FEROZ, MD
GOFORTH, HAROLD WILLIAM JR,
MD
2/15/2011
2/1/2013
2/1/2018 PSYCHIATRY
7/1/2010
7/1/2015 PSYCHIATRY
5/1/2013
5/1/2018 PSYCHIATRY
4/3/2009
12/1/2010
4/3/2014 PSYCHIATRY
7/1/2010
7/1/2015 PSYCHIATRY
4/1/2013
4/1/2018 PSYCHIATRY
8/21/2009
3/15/2011
11/1/2012
10/15/2010 10/15/2015 PSYCHIATRY
PSYCHOSOMATIC
8/29/2008
8/29/2013 MEDICINE
Practice City
NEW HAVEN
CT
GEORGETOW
N
TX
FORT WORTH TX
12/15/2010 12/15/2015 PSYCHIATRY
3/1/2012
3/1/2017 PSYCHIATRY
P4712
N8246
N7008
Secondary Specialty
(Self-Designated)
ADDICTION
PSYCHIATRY
PSYCHOSOMATIC
MEDICINE
Registration
Status of
Practice
Texas
State
License
CHILD AND
ADOLESCENT
PSYCHIATRY
WINDSOR
LONGVIEW
MO
TX
DALLAS
TX
DALLAS
TX
PSYCHOSOMATIC
MEDICINE
HOUSTON
TX
CHILD AND
ADOLESCENT
PSYCHIATRY
SAN ANTONIO TX
NEUROPSYCHIATRY SAN ANTONIO TX
CHILD AND
ADOLESCENT
PSYCHIATRY
PSYCHOSOMATIC
MEDICINE
PEDIATRIC
PSYCHIATRY
PALLIATIVE
MEDICINE
Page 274 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
12/12/2012 None
N/A
8/15/2013 None
N/A
ACTIVE
ACTIVE
12/31/2010 None
3/5/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
10/22/2012 None
12/27/2010 None
N/A
N/A
6/4/2010 None
1/12/2011 None
N/A
N/A
2/15/2011 None
2/5/2013 None
N/A
N/A
ACTIVE
7/15/2010 None
N/A
ACTIVE
5/7/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/8/2009 None
2/3/2011 None
N/A
N/A
7/1/2010 None
N/A
DALLAS
TX
ACTIVE
4/8/2013 None
N/A
EL PASO
TX
ACTIVE
8/31/2009 None
N/A
GALVESTON
TX
ACTIVE
3/30/2011 None
N/A
DALLAS
TX
1/8/2013 None
N/A
LUBBOCK
tx
ACTIVE
LICENSE
ISSUED
10/15/2010 None
N/A
DURHAM
NC
ACTIVE
9/5/2008 None
N/A
License
Number
P6954
Physician Name
CASAL-FERNANDEZ, ALYN
CRISTINA, MD
AM00024 DE MASI, LEON GREGORY, MD
edicaid
edicaid
End Date
Designated)
6/14/2013
Secondary Specialty
(Self-Designated)
PUBLIC
HEALTH/PREVENTIVE
6/14/2018 MEDICINE (GENERAL)
10/15/2012 10/15/2017
N7770
ABU-HIJLEH, MUHANNED A, MD
10/1/2010
10/1/2015
N3464
AWAB, AHMED , MD
8/21/2009
8/21/2014
P4633
BEZWADA, VISHNU VINOD, MD
10/15/2012 10/15/2017
P1201
BHAT, UDAYA M, MD
10/17/2011 10/17/2016
P5934
BLOW, BENJAMIN JAMES, MD
P1274
BRAR, INDERJEET S, MD
P2202
BRITO, VERONICA DE CASTRO
FRANCISCO ESTEVAM DE, MD
P3132
4/1/2013
4/1/2018
11/4/2011
11/4/2016
3/1/2012
3/1/2017
CHAUDHRY, SARMAD MUNIR, MD
5/15/2012
5/15/2017
N8629
CHAVEZ PAZ, JUAN MARCOS, MD
2/4/2011
2/4/2016
P0021
CHELIKANI, MURALIKRISHNA
VENKATANARASIMHA, MD
6/15/2011
6/15/2016
P4745
COOLE, SCOTT JOSEPH, DO
11/1/2012
11/1/2017
PUBLIC
HEALTH/PREVENTIVE
MEDICINE (GENERAL)
PULMONARY
CRITICAL CARE
MEDICINE
SLEEP MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
INTERNAL MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
SLEEP MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
INTERNAL MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
SLEEP MEDICINE
PULMONARY
CRITICAL CARE
CRITICAL CARE
MEDICINE
MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
INTERNAL MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
Page 275 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
PROVIDENCE RI
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
6/18/2013 None
N/A
ACTIVE
10/23/2012 None
N/A
ACTIVE
DELINQUEN
T-NON
PAYMENT
10/5/2010 None
N/A
11/19/2009 None
N/A
LICENSE
ISSUED
10/15/2012 None
N/A
MOUNT
LAUREL
NJ
ACTIVE
10/26/2011 None
N/A
HOUSTON
TX
ACTIVE
4/4/2013 None
N/A
MASSILLON
OH
ACTIVE
11/28/2011 None
N/A
MINEOLA
NY
ACTIVE
3/8/2012 None
N/A
DALLAS
TX
ACTIVE
6/15/2012 None
N/A
2/4/2011 None
N/A
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
6/21/2011 None
N/A
MESA
AZ
ACTIVE
12/10/2012 None
N/A
License
Number
Physician Name
P3309
DAVALOS, KARLA DIAZ, MD
P1858
DE GORORDO ARZAMENDI,
ANTONIO, MD
P5171
DHOTRE, DHEERAJ, MD
P0045
EL-ATFY, ASSER, MD
P5620
ELJAMMAL, SAM, MD
P6815
FERNANDEZ, JUAN FELIPE, MD
P5979
GRAHAM, TIMUR TAFARI, MD
N8301
HANNA, HALIM, MD
N3075
HATEM, CARLO MAJID , MD
P7470
HUIZAR, ISHAM ALEJANDRO, MD
N6377
ISIGUZO, MANICA, MD
N3095
JANJUA, MUHAMMAD TARIQ, MD
P2692
JOHN, REVERLY, MD
edicaid
edicaid
End Date
Designated)
PULMONARY
CRITICAL CARE
6/1/2012
6/1/2017 MEDICINE
PULMONARY
CRITICAL CARE
1/17/2012
1/17/2017 MEDICINE
PULMONARY
CRITICAL CARE
1/4/2013
1/4/2018 MEDICINE
PULMONARY
CRITICAL CARE
6/15/2011
6/15/2016 MEDICINE
PULMONARY
CRITICAL CARE
3/1/2013
3/1/2018 MEDICINE
PULMONARY
CRITICAL CARE
6/3/2013
6/3/2018 MEDICINE
PULMONARY
CRITICAL CARE
4/1/2013
4/1/2018 MEDICINE
PULMONARY
CRITICAL CARE
12/15/2010 12/15/2015 MEDICINE
PULMONARY
CRITICAL CARE
5/29/2009
5/29/2014 MEDICINE
PULMONARY
CRITICAL CARE
8/1/2013
8/1/2018 MEDICINE
PULMONARY
CRITICAL CARE
6/4/2010
6/4/2015 MEDICINE
PULMONARY
CRITICAL CARE
5/29/2009
5/29/2014 MEDICINE
PULMONARY
CRITICAL CARE
4/2/2012
4/2/2017 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
TX
LICENSE
ISSUED
INTERNAL MEDICINE BOSTON
MA
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/1/2012 None
N/A
2/17/2012 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
1/4/2013 None
N/A
SLEEP MEDICINE
LICENSE
ISSUED
6/15/2011 None
N/A
INTERNAL MEDICINE LOS ANGELES CA
ACTIVE
3/7/2013 None
N/A
ACTIVE
6/14/2013 None
N/A
INTERNAL MEDICINE
ACTIVE
4/3/2013 None
N/A
SLEEP MEDICINE
LICENSE
ISSUED
12/15/2010 None
N/A
EL PASO
SLEEP MEDICINE
EL PASO
TX
TX
ACTIVE
6/22/2009 None
N/A
TX
ACTIVE
8/12/2013 None
N/A
6/4/2010 None
N/A
6/17/2009 None
N/A
4/2/2012 None
N/A
LICENSE
ISSUED
INTERNAL MEDICINE
CRITICAL CARE
MEDICINE
INTERNAL MEDICINE
Page 276 of 301
SAINT PAUL
MN
ACTIVE
LICENSE
ISSUED
edicaid
edicaid
License
Physician Name
Start Date
End Date
Designated)
PULMONARY
CRITICAL CARE
L6970
KALEEKAL, THOMAS STEPHEN, MD
6/15/2011
6/15/2016 MEDICINE
PULMONARY
KIRUMAKI, ASHOK SATYAMURTHY,
CRITICAL CARE
P3021
MD
5/1/2012
5/1/2017 MEDICINE
PULMONARY
KRISHNAMURTHY,
CRITICAL CARE
N6437
RAGHAVENDRA, MD
6/4/2010
6/4/2015 MEDICINE
PULMONARY
CRITICAL CARE
N8026
LE, LONG NGUYEN XUAN, MD
10/29/2010 10/29/2015 MEDICINE
PULMONARY
CRITICAL CARE
P2892
LIN, YANN-BOR, MD
4/13/2012
4/13/2017 MEDICINE
PULMONARY
CRITICAL CARE
P5410
LIOU, ROBERT DAR TEH, MD
2/1/2013
2/1/2018 MEDICINE
PULMONARY
CRITICAL CARE
N4562
LUY LOSSIO, GERMAN, MD
11/6/2009
11/6/2014 MEDICINE
PULMONARY
CRITICAL CARE
P0102
MUHAMMAD, ASIF ALI, MD
6/15/2011
6/15/2016 MEDICINE
PULMONARY
CRITICAL CARE
N8047
MURILLO, BORIS ALBERTO, MD
10/29/2010 10/29/2015 MEDICINE
PULMONARY
CRITICAL CARE
N7644
NAMBIAR, ANOOP MANAYIL, MD
9/1/2010
9/1/2015 MEDICINE
PULMONARY
ORTIZ-CANTILLO, KATHIA
CRITICAL CARE
N1036
ALEXANDRA, MD
8/29/2008
8/29/2013 MEDICINE
PULMONARY
CRITICAL CARE
N1412
PANCHAL, ROHIT P, MD
10/10/2008 10/10/2013 MEDICINE
PULMONARY
CRITICAL CARE
P5448
PAYAN, HECTOR A, MD
2/1/2013
2/1/2018 MEDICINE
Secondary Specialty
(Self-Designated)
SLEEP MEDICINE
Practice City
MILWAUKEE
INTERNAL MEDICINE SAINT LOUIS
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
WI
ACTIVE
6/20/2011 None
N/A
MO
ACTIVE
5/3/2012 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
ACTIVE
11/3/2010 None
N/A
LICENSE
ISSUED
4/13/2012 None
N/A
SLEEP MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
INTERNAL MEDICINE ORANGE
CA
ACTIVE
2/5/2013 None
N/A
TX
ACTIVE
11/11/2009 None
N/A
LICENSE
ISSUED
6/15/2011 None
N/A
LICENSE
ISSUED
10/29/2010 None
N/A
SLEEP MEDICINE
SAN ANTONIO TX
ACTIVE
9/6/2010 None
N/A
SAN ANTONIO TX
ACTIVE
9/30/2008 None
N/A
INTERNAL MEDICINE GREENWOOD MS
ACTIVE
11/17/2008 None
N/A
ACTIVE
2/22/2013 None
N/A
SLEEP MEDICINE
Page 277 of 301
License
Number
Physician Name
P2343
PILLAI, REGINA , MD
P0276
PUENTE CUELLAR, NAPOLEON
ANTONIO, MD
P0865
QURESHI, ATIF SALEEM, MD
P3233
REDDY, JAGADESHWAR GUMMI,
MD
N3270
RHOTON, WILLIAM ALAN , MD
P3069
SALGADO GONZALEZ, GONZALO
ALEJANDRO, MD
N5998
SANTACRUZ, JOSE FERNANDO,
MD
P1138
SARASWAT, SHANTANU, MD
P7032
SAYIED, TAUSIF, MD
P3582
SEIDEN, JASON ANDREW, MD
P1594
SIDDIQUE, MUHAMMAD ASIM, MD
N7976
TRINH, CINDY , MD
N9790
URAGODA, LALITH CHRISANTHA,
MD
edicaid
edicaid
End Date
Designated)
PULMONARY
CRITICAL CARE
3/1/2012
3/1/2017 MEDICINE
PULMONARY
CRITICAL CARE
7/1/2011
7/1/2016 MEDICINE
PULMONARY
CRITICAL CARE
8/26/2011
8/26/2016 MEDICINE
PULMONARY
CRITICAL CARE
5/15/2012
5/15/2017 MEDICINE
PULMONARY
CRITICAL CARE
5/29/2009
5/29/2014 MEDICINE
PULMONARY
CRITICAL CARE
5/1/2012
5/1/2017 MEDICINE
PULMONARY
CRITICAL CARE
4/9/2010
4/9/2015 MEDICINE
PULMONARY
CRITICAL CARE
10/3/2011
10/3/2016 MEDICINE
PULMONARY
CRITICAL CARE
6/14/2013
6/14/2018 MEDICINE
PULMONARY
CRITICAL CARE
6/8/2012
6/8/2017 MEDICINE
PULMONARY
CRITICAL CARE
12/1/2011
12/1/2016 MEDICINE
PULMONARY
CRITICAL CARE
10/15/2010 10/15/2015 MEDICINE
PULMONARY
CRITICAL CARE
5/16/2011
5/16/2016 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
3/8/2012 None
N/A
ACTIVE
7/14/2011 None
N/A
SLEEP MEDICINE
LICENSE
ISSUED
8/26/2011 None
N/A
FORT WORTH TX
ACTIVE
5/17/2012 None
N/A
THE
INTERNAL MEDICINE WOODLANDS TX
ACTIVE
6/12/2009 None
N/A
SLEEP MEDICINE
ACTIVE
5/3/2012 None
N/A
TX
ACTIVE
4/16/2010 None
N/A
AZ
ACTIVE
10/20/2011 None
N/A
LICENSE
ISSUED
6/14/2013 None
N/A
SUNCITY
WEST
SLEEP MEDICINE
SLEEP MEDICINE
FORT WORTH TX
ACTIVE
6/13/2012 None
N/A
SLEEP MEDICINE
HOUSTON
ACTIVE
12/20/2011 None
N/A
ACTIVE
10/28/2010 None
N/A
ACTIVE
6/3/2011 None
N/A
TX
INTERNAL MEDICINE
SLEEP MEDICINE
Page 278 of 301
BOWLING
GREEN
KY
License
Number
Physician Name
P4523
UYSAL, ASKIN, MD
N2328
VALLEJO-MANZUR, JOSE
FEDERICO, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
PULMONARY
CRITICAL CARE
9/17/2012
9/17/2017 MEDICINE
SLEEP MEDICINE
PULMONARY
CRITICAL CARE
2/6/2009
2/6/2014 MEDICINE
INTERNAL MEDICINE
PULMONARY
CRITICAL CARE
5/1/2012
5/1/2017 MEDICINE
PULMONARY
CRITICAL CARE
1/15/2013
1/15/2018 MEDICINE
SLEEP MEDICINE
PULMONARY
CRITICAL CARE
10/3/2011
10/3/2016 MEDICINE
PULMONARY
CRITICAL CARE
12/15/2011 12/15/2016 MEDICINE
P3093
VELEY, GENE, MD
P5312
WADI, MUSA, MD
P1155
ZARATE CACERES, HERNAN
ALEXANDER, MD
P1717
ZEATER, MOHAMED YASER, MD
L2118
BAG, REMZI, MD
2/1/2013
P7416
COLLEN, JACOB FREDRICK, MD
8/1/2013
N5153
2/5/2010
N1885
KERSHAW, COREY DEAN, MD
SCHWARCZ, RICARDO MARTIN,
MD
12/12/2008
N8262
ABBASI, ARSHAD ABID, MD
12/15/2010
P7235
ABUNASSER, JAFAR JAMIL, MD
7/15/2013
N1247
AJELABI, AKINYINKA ABIDEMI, MD
10/10/2008
N1642
GARCIA, HERNANDO , MD
12/12/2008
P0615
KHAN, AZHAR ULLAH, MD
8/1/2011
P2883
KOHAN, JAMES MICHAEL, MD
4/13/2012
PULMONARY
2/1/2018 DISEASES
PULMONARY
8/1/2018 DISEASES
PULMONARY
2/5/2015 DISEASES
PULMONARY
12/12/2013 DISEASES
PULMONARY
12/15/2015 MEDICINE
PULMONARY
7/15/2018 MEDICINE
PULMONARY
10/10/2013 MEDICINE
PULMONARY
12/12/2013 MEDICINE
PULMONARY
8/1/2016 MEDICINE
PULMONARY
4/13/2017 MEDICINE
CRITICAL CARE
MEDICINE
CRITICAL CARE
MEDICINE (IM)
CRITICAL CARE
MEDICINE (IM)
CRITICAL CARE
MEDICINE (IM)
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
WEST
MONROE
LA
ACTIVE
9/27/2012 None
N/A
MCALLEN
TX
ACTIVE
3/26/2009 None
N/A
COLLEGE
STATION
TX
ACTIVE
5/21/2012 None
N/A
LICENSE
ISSUED
1/15/2013 None
N/A
11/21/2011 None
N/A
12/15/2011 None
N/A
2/1/2013 None
N/A
8/6/2013 None
N/A
2/5/2010 None
N/A
12/22/2008 None
N/A
1/5/2011 None
N/A
7/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
SAN ANTONIO TX
HARLINGEN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
CRITICAL CARE
MEDICINE (IM)
SLEEP MEDICINE
CRITICAL CARE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
CLEVELAND
TX
ACTIVE
10/14/2008 None
N/A
TX
ACTIVE
12/17/2008 None
N/A
SLEEP MEDICINE
EL PASO
OKLAHOMA
CITY
OK
ACTIVE
8/9/2011 None
N/A
SLEEP MEDICINE
DEL MAR
CA
ACTIVE
4/18/2012 None
N/A
Page 279 of 301
License
Number
K9339
Physician Name
edicaid
edicaid
End Date
Designated)
P0694
MAGDY, KHALED RATEB, MD
ALBUQUERQUE, KEVIN VINCENT
DE PAUL, MD
2/15/2011
N7904
BARANI, IGOR JOHAN, MD
P4548
BHAVSAR, SHRIPAL KANTILAL, MD
N5595
BROWN, PAUL DAVID, MD
4/9/2010
N2438
CHEN, JEFFREY , MD
4/3/2009
N5619
CHENG, JONATHAN CHI-HONG, MD
4/9/2010
N5625
CHOE, KEVIN S, MD
4/9/2010
N9188
CHUNG, ERIC, MD
4/1/2011
P1286
COX, JOHN A, MD
11/4/2011
N9841
DEB, NILOYJYOTI, MD
6/3/2011
L2364
DEROBERTIS, ANGELA, MD
4/9/2010
J4094
DUONG, PAUL LIEM, MD
3/1/2012
P0977
FULLER, CLIFTON DAVID, MD
P2650
GHIA, AMOL JITENDRA, MD
4/2/2012
N6314
GODINEZ-PUEBLA, JUAN , MD
6/4/2010
N9061
HANNAN, RAQUIBUL, MD
P3340
HAQUE, WAQAR MOHAMMAD, MD
N3084
HOFFMAN, KAREN ELIZABETH , MD
N6383
IYENGAR, PUNEETH , MD
8/15/2011
10/15/2010
10/1/2012
9/15/2011
3/15/2011
6/1/2012
5/29/2009
6/4/2010
PULMONARY
2/15/2016 MEDICINE
RADIATION
8/15/2016 ONCOLOGY
RADIATION
10/15/2015 ONCOLOGY
RADIATION
10/1/2017 ONCOLOGY
RADIATION
4/9/2015 ONCOLOGY
RADIATION
4/3/2014 ONCOLOGY
RADIATION
4/9/2015 ONCOLOGY
RADIATION
4/9/2015 ONCOLOGY
RADIATION
4/1/2016 ONCOLOGY
RADIATION
11/4/2016 ONCOLOGY
RADIATION
6/3/2016 ONCOLOGY
RADIATION
4/9/2015 ONCOLOGY
RADIATION
3/1/2017 ONCOLOGY
RADIATION
9/15/2016 ONCOLOGY
RADIATION
4/2/2017 ONCOLOGY
RADIATION
6/4/2015 ONCOLOGY
RADIATION
3/15/2016 ONCOLOGY
RADIATION
6/1/2017 ONCOLOGY
RADIATION
5/29/2014 ONCOLOGY
RADIATION
6/4/2015 ONCOLOGY
Secondary Specialty
(Self-Designated)
Practice City
CRITICAL CARE
MEDICINE (IM)
DAYTON
BRACHYTHERAPY/HY
PERTHERMIA
DALLAS
SAN
FRANCISCO
THERAPEUTIC
RADIOLOGY
Page 280 of 301
Registration
Status of
Practice
Texas
State
License
TEXAS
LICENSE
TX
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/15/2011 None
N/A
TX
ACTIVE
8/25/2011 None
N/A
CA
ACTIVE
10/25/2010 None
N/A
ACTIVE
10/12/2012 None
N/A
ROCHESTER
MN
ACTIVE
4/28/2010 None
N/A
BASTROP
TX
ACTIVE
4/17/2009 None
N/A
HOUSTON
TX
ACTIVE
4/20/2010 None
N/A
DALLAS
TX
ACTIVE
4/28/2010 None
N/A
HOUSTON
TX
ACTIVE
4/6/2011 None
N/A
GALVESTON
TX
ACTIVE
11/11/2011 None
N/A
ACTIVE
6/14/2011 None
N/A
TEMPLE
LOS
ALAMITOS
TX
ACTIVE
4/14/2010 None
N/A
CA
ACTIVE
3/12/2012 None
N/A
HOUSTON
TX
ACTIVE
11/2/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
4/13/2012 None
N/A
6/4/2010 None
N/A
DALLAS
TX
ACTIVE
3/22/2011 None
N/A
GALVESTON
TX
ACTIVE
6/7/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
6/3/2009 None
N/A
6/4/2010 None
N/A
License
Number
Physician Name
N5750
JONES, WILLIAM ELTON III, MD
N1698
JOYNER, MELISSA M, MD
P1884
KELLY, DOUGLAS A, MD
N7821
KELLY, ELISABETH , MD
P7791
KIM, MICHELLE MIRAN, MD
P3033
P6999
LUBBE, WILHELM , MD
MABANTA, SHEILAINE RODRIGO,
MD
P3035
MAHMOOD, USAMA , MD
P3651
MONAGHAN, MICAH, MD
P7521
NEDELKA, MICHELE, MD
P6478
NGUYEN, DOMINIC DUNG, MD
N3228
PARK, CLINTON SANGKYU, MD
P2330
PATEL, MEHUL KIRIT, MD
P7183
PATIL, SACHIN SHYAM, MD
N8138
PINNIX, CHELSEA CAMILLE, MD
P3430
ROMAN, NICHOLAS ORDUNO, MD
N2799
SHARP, HADLEY JEAN, MD
P7208
SHI, ZHENG, MD
P1698
SKINNER, HEATH DEVIN, MD
N1896
SMITH, BENJAMIN DAVID, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
RADIATION
4/9/2010
4/9/2015 ONCOLOGY
RADIATION
12/12/2008 12/12/2013 ONCOLOGY
RADIATION
1/17/2012
1/17/2017 ONCOLOGY
RADIATION
10/1/2010
10/1/2015 ONCOLOGY
RADIATION
8/30/2013
8/30/2018 ONCOLOGY
RADIATION
5/1/2012
5/1/2017 ONCOLOGY
RADIATION
6/14/2013
6/14/2018 ONCOLOGY
RADIATION
5/1/2012
5/1/2017 ONCOLOGY
RADIATION
6/15/2012
6/15/2017 ONCOLOGY
RADIATION
8/1/2013
8/1/2018 ONCOLOGY
RADIATION
RADIATION
5/1/2013
5/1/2018 ONCOLOGY
ONCOLOGY
RADIATION
5/29/2009
5/29/2014 ONCOLOGY
RADIATION
3/1/2012
3/1/2017 ONCOLOGY
RADIATION
7/1/2013
7/1/2018 ONCOLOGY
RADIATION
11/15/2010 11/15/2015 ONCOLOGY
INTERNAL MEDICINE
RADIATION
6/1/2012
6/1/2017 ONCOLOGY
RADIATION
4/3/2009
4/3/2014 ONCOLOGY
RADIATION
7/1/2013
7/1/2018 ONCOLOGY
RADIATION
12/15/2011 12/15/2016 ONCOLOGY
RADIATION
12/12/2008 12/12/2013 ONCOLOGY
Page 281 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
TULSA
OK
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
4/19/2010 None
N/A
ACTIVE
12/29/2008 None
N/A
ACTIVE
1/20/2012 None
N/A
ACTIVE
10/13/2010 None
N/A
ACTIVE
9/9/2013 None
N/A
SPRING
TX
ACTIVE
6/22/2012 None
N/A
DECATUR
TX
ACTIVE
LICENSE
ISSUED
6/19/2013 None
N/A
5/1/2012 None
N/A
6/18/2012 None
N/A
8/5/2013 None
N/A
5/1/2013 None
N/A
PORT
ARTHUR, TX
TX
ACTIVE
KERRVILLE
TX
ACTIVE
LICENSE
ISSUED
FORT WORTH TX
ACTIVE
6/16/2009 None
N/A
TEMPLE
TX
ACTIVE
3/7/2012 None
N/A
HOUSTON
TX
ACTIVE
7/15/2013 None
N/A
HOUSTON
TX
ACTIVE
11/18/2010 None
N/A
SAN ANTONIO TX
ACTIVE
6/11/2012 None
N/A
ACTIVE
5/15/2009 None
N/A
ACTIVE
7/2/2013 None
N/A
TX
ACTIVE
12/22/2011 None
N/A
TX
ACTIVE
12/29/2008 None
N/A
HOUSTON
LACKLAND
AFB
License
Number
Physician Name
P0305
SWANSON, TODD A, MD
P6532
TANIGUCHI, CULLEN MITSUO, MD
N7009
THATIKONDA, SRIVANI, MD
N7591
THAWANI, NITIKA, MD
N3349
TIERNEY, RYAN MENZIES , MD
N5436
TISDALE, BERNARD ALVAN, MD
P3098
WESTOVER, KENNETH, MD
P0942
WOLSKI, MICHAL JACEK, MD
N9011
WOO, VAN HOY, MD
N1965
YOUSSEF, EMAD FOUAD, MD
P6758
ABBARA, SUHNY, MD
N4881
ADHIKARY, RAVI , MD
P2569
P7238
AKLE, NASSIM , MD
ALFORD, RAPHAEL ETARIO, MD
N7900
ALVI, NAVEED IKRAM, MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
Practice City
RADIATION
7/1/2011
7/1/2016 ONCOLOGY
GALVESTON
RADIATION
5/1/2013
5/1/2018 ONCOLOGY
RADIATION
7/1/2010
7/1/2015 ONCOLOGY
INTERNAL MEDICINE
RADIATION
8/27/2010
8/27/2015 ONCOLOGY
RADIATION
5/29/2009
5/29/2014 ONCOLOGY
AUSTIN
RADIATION
2/5/2010
2/5/2015 ONCOLOGY
RADIATION
5/1/2012
5/1/2017 ONCOLOGY
DALLAS
RADIATION
9/1/2011
9/1/2016 ONCOLOGY
GALVESTON
RADIATION
3/1/2011
3/1/2016 ONCOLOGY
TULSA
RADIATION
12/12/2008 12/12/2013 ONCOLOGY
PHOENIX
CARDIOTHORACIC
6/3/2013
6/3/2018 RADIOLOGY
RADIOLOGY
BOSTON
2/5/2010
2/5/2015 RADIOLOGY
4/2/2012
7/15/2013
4/2/2017 RADIOLOGY
7/15/2018 RADIOLOGY
10/15/2010 10/15/2015 RADIOLOGY
TM00457 AMOLI, SEAN REZA, MD
N9342
ANWAR, MOHSEN, DO
8/1/2011
4/8/2011
8/1/2016 RADIOLOGY
4/8/2016 RADIOLOGY
TM00458 ARAIZA, BEATRIX , MD
8/1/2011
8/1/2016 RADIOLOGY
N4922
ASH, LORRAINE MARJORIE, DO
2/5/2010
2/5/2015 RADIOLOGY
N4929
BAILEY, YVETTE, MD
2/5/2010
2/5/2015 RADIOLOGY
N7774
BANGASH, AFFAAN KHAN, DO
10/1/2010
10/1/2015 RADIOLOGY
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
N/A
ACTIVE
LICENSE
ISSUED
5/20/2013 None
N/A
7/1/2010 None
N/A
TX
ACTIVE
8/31/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
6/9/2009 None
N/A
2/5/2010 None
N/A
TX
ACTIVE
5/7/2012 None
N/A
TX
ACTIVE
9/7/2011 None
N/A
OK
ACTIVE
4/6/2011 None
N/A
AZ
ACTIVE
1/30/2009 None
N/A
MA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/7/2013 None
N/A
2/5/2010 None
N/A
4/2/2012 None
7/17/2013 None
N/A
N/A
10/15/2010 None
N/A
8/1/2011 None
4/15/2011 None
N/A
N/A
8/1/2011 None
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
10/1/2010 None
N/A
RADIOLOGY
AURORA
NEURORADIOLOGY
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
Page 282 of 301
Disciplinary
Status Date
7/8/2011 None
TX
IL
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
P1962
Physician Name
P2589
BASLER, JOSEPH THEODORE, MD
BATHALA, THARAKESWARA
KUMAR, MD
P6138
P5034
P5034
P5034
BATRA, KIRAN, MD
BERJE, ALBERT, MD
BERJE, ALBERT, MD
BERJE, ALBERT, MD
TM00463 BESSETTE, PETER RICHARD, MD
N4299
BIRT, BRADLEY BLAIR, MD
P6340
BLOOM, DANIEL GORDON, MD
edicaid
edicaid
End Date
Designated)
2/1/2012
4/2/2012
2/1/2017 RADIOLOGY
4/2/2017 RADIOLOGY
8/15/2016 RADIOLOGY
11/6/2014 RADIOLOGY
5/1/2018 RADIOLOGY
6/3/2011
6/3/2016 RADIOLOGY
TM00470 BREGER, ROBERT KARL, MD
9/1/2011
9/1/2016 RADIOLOGY
N9520
5/2/2011
5/2/2016 RADIOLOGY
BLUNCK, JOSHUA THOMAS, DO
BROWNE, LORNA , MD
P5159
BRUNNER, NOEMI , MD
N0670
P2103
P2967
BUTLER, GORDON MARION III, MD
CARSON, WILLIAM KEITH, MD
CHAN, ROXANNE, MD
CHAPLYNSKY, MARTA JOANNA,
MD
CHASEN, NOAH NATHAN, MD
N8628
N4340
CHINTALAPUDI, UDAYA BHASKARA
TM00502 RAO, MD
TM00408 CHONG, CHRISTOPHER LEE, MD
N7996
N4347
N8084
CHONG, KOK LEUNG, MD
CHU, VINCENT , MD
CHUANG, YI- JU , MD
N7408
CHWOSCHTSCHINSKY, ELISA , MD
COMPTON, LINDSAY
MATWIJECKY, MD
N2993
DIAGNOSTIC
RADIOLOGY
Practice City
1/4/2013
1/4/2018 RADIOLOGY
8/29/2008
2/10/2012
5/1/2012
8/29/2013 RADIOLOGY
2/10/2017 RADIOLOGY
5/1/2017 RADIOLOGY
2/4/2011
11/6/2009
2/4/2016 RADIOLOGY
11/6/2014 RADIOLOGY
2/1/2012
2/1/2017 RADIOLOGY
1/18/2011
1/18/2016 RADIOLOGY
10/29/2010 10/29/2015 RADIOLOGY
11/6/2009
11/6/2014 RADIOLOGY
11/15/2010 11/15/2015 RADIOLOGY
8/16/2010
8/16/2015 RADIOLOGY
5/29/2009
5/29/2014 RADIOLOGY
2/7/2012 None
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
4/9/2012 None
N/A
MILWAUKEE
6621 FANNIN
ST
EMERGENCY/TRAUM
A RADIOLOGY
EL PASO
DALLAS
HOUSTON
ATLANTA
TX
TX
TX
BIRMINGHAM
4/12/2013
1/1/2013
1/1/2013
1/1/2013
None
None
None
None
N/A
N/A
N/A
N/A
8/15/2011 None
12/9/2009 None
5/22/2013 None
N/A
N/A
N/A
6/3/2011 None
N/A
WI
ACTIVE
10/11/2011 None
N/A
TX
ACTIVE
5/18/2011 None
N/A
TX
ACTIVE
1/10/2013 None
N/A
TX
TX
GA
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
9/12/2008 None
2/28/2012 None
5/3/2012 None
N/A
N/A
N/A
2/4/2011 None
11/24/2009 None
N/A
N/A
NEUROLOGY
AL
ACTIVE
2/29/2012 None
N/A
SACRAMENTO CA
ACTIVE
1/25/2011 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
11/3/2010 None
11/16/2009 None
11/18/2010 None
N/A
N/A
N/A
SHREVEPORT LA
ACTIVE
8/30/2010 None
N/A
ACTIVE
6/4/2009 None
N/A
INTERVENTIONAL
RADIOLOGY
Page 283 of 301
Disciplinary
Status Date
ACTIVE
HOUSTON
AUSTIN
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
SPRINGFIELD IL
4/12/2013
4/12/2018 RADIOLOGY
12/17/2012 12/17/2017 RADIOLOGY
12/17/2012 12/17/2017 RADIOLOGY
12/17/2012 12/17/2017 RADIOLOGY
8/15/2011
11/6/2009
5/1/2013
N9814
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
License
Number
Physician Name
N9834
COOK, CASSY LYNN, MD
TM00464 COOLEY, PETER ALEXANDER, MD
N4996
CREEL, CHRISTOPHER, MD
N7788
P4436
N3622
P2980
K7012
CROWDER, JASON BRADLEY, MD
DHEER, SACHIN, MD
DO, MICHAEL KIM, MD
DOE, JENNIFER WEN, MD
DUONG, ROBERT TRIEU, MD
N6280
ELINE, MARY JO, DO
P1072
P1545
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
6/3/2011
6/3/2016 RADIOLOGY
NEURO-RADIOLOGY
8/15/2011
8/15/2016 RADIOLOGY
2/5/2010
2/5/2015 RADIOLOGY
10/1/2010
9/17/2012
8/21/2009
5/1/2012
7/1/2011
10/1/2015
9/17/2017
8/21/2014
5/1/2017
7/1/2016
RADIOLOGY
RADIOLOGY
RADIOLOGY
RADIOLOGY
RADIOLOGY
RADIOLOGY
BREAST IMAGING
NEURO-RADIOLOGY
Practice City
HOUSTON
GULFPORT
CHERRY HILL
TEMPLE
MONTCLAIR
TAMPA
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
MS
NJ
TX
NJ
FL
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
6/13/2011 None
N/A
8/15/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/13/2010
9/24/2012
11/12/2009
5/18/2012
7/7/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
6/4/2010 None
N/A
6/4/2010
6/4/2015 RADIOLOGY
FIERKE, SHELBY RYAN, MD
10/3/2011
10/3/2016 RADIOLOGY
PEDIATRIC
RADIOLOGY
CINCINNATI
OH
ACTIVE
10/12/2011 None
N/A
12/1/2011
12/1/2016 RADIOLOGY
BREAST IMAGING
LUBBOCK
TX
N/A
2/5/2010
3/15/2012
2/5/2015 RADIOLOGY
3/15/2017 RADIOLOGY
NEURO-RADIOLOGY
NEW YORK
NY
2/5/2010 None
4/4/2012 None
N/A
N/A
N7090
GINOS, JASON , MD
7/15/2010
7/15/2015 RADIOLOGY
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/30/2011 None
N5070
P2446
FORNARI, GIANLUIGI ALOISIO, MD
GATES, CAMERON HERSCHEL JR,
DO
GEBARA, NATHALIE, MD
7/15/2010 None
N/A
10/17/2011 None
N/A
ACTIVE
ACTIVE
10/11/2010 None
2/18/2013 None
N/A
N/A
WI
ACTIVE
12/30/2011 None
N/A
NM
ACTIVE
12/21/2012 None
N/A
NM
ACTIVE
12/21/2012 None
N/A
NM
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/21/2012 None
11/11/2011 None
N/A
N/A
4/12/2013 None
N/A
8/15/2011 None
N/A
TM00479 GRAY, DANA ANN, MD
GUPTON, THEODORE BRYAN JR,
N7804
MD
P5371
HAGOPIAN, TARA , DO
HALLENBECK, KATHERINE ANN,
TM00493 MD
10/17/2011 10/17/2016 RADIOLOGY
TM00532 HAMMER, RICHARD A, MD
12/17/2012 12/17/2017 RADIOLOGY
12/17/2012 12/17/2017 RADIOLOGY
P1321
HANNON, PAUL JOSEPH III, MD
12/17/2012 12/17/2017 RADIOLOGY
11/4/2011
11/4/2016 RADIOLOGY
P6177
10/1/2010
2/1/2013
10/1/2015 RADIOLOGY
2/1/2018 RADIOLOGY
12/15/2011 12/15/2016 RADIOLOGY
HAPP, ERIN MARIE, DO
4/12/2013
4/12/2018 RADIOLOGY
TM00466 HARDIE, ROBERT CHARLES, MD
8/15/2011
8/15/2016 RADIOLOGY
NEURO-RADIOLOGY
BREAST IMAGING
Page 284 of 301
MILWAUKEE
ALBUQUERQU
E
ALBUQUERQU
E
ALBUQUERQU
E
License
Number
N5100
P1461
Physician Name
HARVEY, CARRIE LYNN, MD
HENDRIX, CHRISTOPHER KYLE,
DO
TM00459 HINKE, DAVID HENRY, MD
edicaid
edicaid
End Date
Designated)
2/5/2010
INTERVENTIONAL
RADIOLOGY
P5537
HWANG, BECKY JUNGSUN, DO
2/8/2013
2/8/2018 RADIOLOGY
N5125
JACKSON, LAWSON ALAN JR, MD
2/5/2010
2/5/2015 RADIOLOGY
P5383
N2131
JACKSON, PAUL MCLEAN, MD
JAVERI, ZAHIR KURBANALI, MD
2/1/2013
2/6/2009
2/1/2018 RADIOLOGY
2/6/2014 RADIOLOGY
NEURORADIOLOGY
8/15/2011
7/1/2011
8/15/2016 RADIOLOGY
7/1/2016 RADIOLOGY
8/1/2011
8/1/2016 RADIOLOGY
P0612
PEORIA
IL
8/1/2016 RADIOLOGY
PEDIATRIC
RADIOLOGY
PEDIATRIC
RADIOLOGY
TM00467 JOSHI, JAIDEEP SHRINIVAS, MD
P0242
KARAK, PRASANTA KUMAR, MD
Practice City
2/5/2015 RADIOLOGY
11/15/2011 11/15/2016 RADIOLOGY
8/1/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
P0419
KATRE, RASHMI SURESH, MD
KAZAN TANNUS, JOAO FERNANDO
, MD
7/15/2011
7/15/2016 RADIOLOGY
P7479
N4517
N7121
KAZIMI, FARZANEH SARAH, MD
KHAN, MOHAMMAD ALI, MD
KHATRI, GAURAV, MD
8/1/2013
11/6/2009
7/15/2010
8/1/2018 RADIOLOGY
11/6/2014 RADIOLOGY
7/15/2015 RADIOLOGY
N4519
N9577
KHOURY, MICHAEL GEORGE II, DO
KIBUULE, DANETTE CALICE, MD
11/6/2009
5/2/2011
11/6/2014 RADIOLOGY
5/2/2016 RADIOLOGY
P6198
KIMYAI-ASADI, MITHRA, MD
4/12/2013
4/12/2018 RADIOLOGY
7/1/2011
7/1/2016 RADIOLOGY
HOUSTON
HOUSTON
TX
TX
RADIOLOGY
ABDOMINAL
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
12/7/2011 None
N/A
8/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/18/2013 None
N/A
2/5/2010 None
N/A
2/1/2013 None
2/25/2009 None
N/A
N/A
8/15/2011 None
7/12/2011 None
N/A
N/A
8/1/2011 None
N/A
GALVESTON
TX
ACTIVE
8/19/2011 None
N/A
PORT LAVACA
HOUSTON
DALLAS
PALM
SPRINGS
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
8/12/2013 None
11/16/2009 None
7/26/2010 None
N/A
N/A
N/A
CA
ACTIVE
ACTIVE
11/20/2009 None
5/18/2011 None
N/A
N/A
MORGANTOW
N
WV
ACTIVE
4/25/2013 None
N/A
NEURO-RADIOLOGY
CINCINNATI
OH
ACTIVE
7/11/2011 None
N/A
NEURO-RADIOLOGY
BEMIDJI
MN
ACTIVE
3/24/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
1/13/2009 None
N/A
1/4/2013 None
11/5/2012 None
N/A
N/A
4/4/2013 None
N/A
TM00451 KODE SAMMARCO, LAKSHMI, MD
KONCHADA, RAVISHANKAR
N8942
SRINIVAS, MD
KRAGHA, KAYIGUVWE
N0904
ONOJUVWEVWO, MD
3/1/2011
3/1/2016 RADIOLOGY
8/29/2008
8/29/2013 RADIOLOGY
LOUISVILLE
KY
P5201
P4587
KUBAL, AMIT ANANT, MD
KUMAR, NEIL MITHILESH, MD
1/4/2013
10/1/2012
1/4/2018 RADIOLOGY
10/1/2017 RADIOLOGY
DALLAS
TX
P6011
KUMAR, RAJIV, MD
4/1/2013
4/1/2018 RADIOLOGY
GENERAL PRACTICE SAN ANTONIO TX
Page 285 of 301
ACTIVE
License
Number
Physician Name
TM00380
P1560
N7449
P1780
P6672
LANDRIEU, LAURA LEGENDRE, MD
LEE, DANIEL WONIL, MD
LEVINE, HAROLD R II, MD
LINCOLN, CHRISTIE MARY, MD
LITTRELL, LAUREL A, MD
P5670
LITVAK, STANLEY JAMES, MD
N5198
P1348
edicaid
edicaid
End Date
Designated)
8/2/2010
12/1/2011
8/16/2010
1/2/2012
5/15/2013
8/2/2015
12/1/2016
8/16/2015
1/2/2017
5/15/2018
RADIOLOGY
RADIOLOGY
RADIOLOGY
RADIOLOGY
RADIOLOGY
3/1/2013
3/1/2018 RADIOLOGY
LLAVE, ALFRED DE CASTRO, MD
LOCKER, MATTHEW JAMES, MD
2/5/2010
11/4/2011
2/5/2015 RADIOLOGY
11/4/2016 RADIOLOGY
P6212
LOH, JOHN CHUCH SHENG, MD
4/12/2013
4/12/2018 RADIOLOGY
N5206
N7305
LUDWIG, DAVID R. , MD
MAES, EARL BLAIR, MD
2/5/2010
8/2/2010
2/5/2015 RADIOLOGY
8/2/2015 RADIOLOGY
P5104
MAHLMANN, MICHAEL RAY, MD
P5104
P5104
P6216
N8539
N7944
N8324
P2303
Secondary Specialty
(Self-Designated)
Practice City
BREAST IMAGING
GULF BREEZE
NEURO-RADIOLOGY
NEURO-RADIOLOGY
BREAST IMAGING
ROCHESTER
POUGHKEEPS
IE
Registration
Status of
Practice
Texas
State
License
FL
TX
MN
NY
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
9/6/2010
12/30/2011
8/20/2010
1/10/2012
5/28/2013
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
3/6/2013 None
N/A
2/5/2010 None
11/17/2011 None
N/A
N/A
4/23/2013 None
N/A
2/5/2010 None
8/23/2010 None
N/A
N/A
MUSCULOSKELETAL
IMAGING
MANCHESTER NH
NUCLEAR
RADIOLOGY
NIXA
MO
ACTIVE
LICENSE
ISSUED
ACTIVE
12/17/2012 12/17/2017 RADIOLOGY
TX
ACTIVE
1/1/2013 None
N/A
12/17/2012 12/17/2017 RADIOLOGY
TX
ACTIVE
1/1/2013 None
N/A
MANZOUL, SAAD MAHMOUDADAM, MD
12/17/2012 12/17/2017 RADIOLOGY
TX
ACTIVE
1/1/2013 None
N/A
TX
ACTIVE
4/19/2013 None
N/A
MARTI, JON K, DO
MARTIN, JOSHUA GORDON, MD
METWALLI, ZEYAD AHMED, MD
MISHRA, MICHAEL DONALD VIJAY,
MD
1/18/2011
1/18/2016 RADIOLOGY
10/15/2010 10/15/2015 RADIOLOGY
12/15/2010 12/15/2015 RADIOLOGY
MUSCULOSKELETAL
RADIOLOGY
PLANO
OCEAN
SPRINGS
TEXARKANA
HOUSTON
MS
TX
TX
ACTIVE
ACTIVE
ACTIVE
1/21/2011 None
10/20/2010 None
1/3/2011 None
N/A
N/A
N/A
TX
ACTIVE
3/12/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
3/7/2011 None
12/21/2010 None
N/A
N/A
6/15/2011 None
11/10/2011 None
2/1/2010 None
N/A
N/A
N/A
ACTIVE
11/29/2012 None
N/A
N8958
N8327
MORALES, ADAM FERNANDO, MD
MURILLO, HORACIO , MD
P0104
P1372
N4611
MURRAY, MATTHEW FOREST, MD
NAKAMURA, LEE MAYUMI, MD
NARRA, PAVAN, MD
TM00531 NEELY, PHILIP E, MD
4/12/2013
3/1/2012
4/12/2018 RADIOLOGY
3/1/2017 RADIOLOGY
3/1/2011
3/1/2016 RADIOLOGY
12/15/2010 12/15/2015 RADIOLOGY
6/15/2011
11/4/2011
11/6/2009
6/15/2016 RADIOLOGY
11/4/2016 RADIOLOGY
11/6/2014 RADIOLOGY
PLANO
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
SAN ANTONIO TX
MUSCULOSKELETAL
RADIOLOGY
11/15/2012 11/15/2017 RADIOLOGY
Page 286 of 301
GALVESTON
TX
MADISON
AL
License
Number
P3396
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
DIAGNOSTIC
RADIOLOGY
Practice City
NEYMAN, EDWARD, MD
6/1/2012
6/1/2017 RADIOLOGY
TM00341 NGUYEN, MICHAEL HUY, MD
NOONAN, PATRICK THOMAS JR,
N8231
MD
OLOUGHLIN, TERENCE JOSEPH,
N7319
MD
N8233
OVERBEEKE, CORNELL, MD
N8438
PARIKH, SACHIN RAJENDRA, MD
2/5/2010
2/5/2015 RADIOLOGY
12/1/2010
12/1/2015 RADIOLOGY
NEURORADIOLOGY
TEMPLE
TX
ACTIVE
8/2/2010
12/1/2010
1/3/2011
8/2/2015 RADIOLOGY
12/1/2015 RADIOLOGY
1/3/2016 RADIOLOGY
NEURORADIOLOGY
ATLANTA
BATAVIA
DALLAS
GA
IL
TX
DALLAS
TX
P2504
P1580
PARISH, DAVID, MD
PEDROSA, IVAN, MD
3/15/2012
12/1/2011
3/15/2017 RADIOLOGY
12/1/2016 RADIOLOGY
P1129
PHILIPS, SHAILE, MD
10/3/2011
10/3/2016 RADIOLOGY
N9280
P1211
PILIKA, ASTI PAVLLO, MD
PORTER, CHAD THOMAS, MD
P3660
PRICE, STEPHEN BRYAN, MD
6/15/2012
6/15/2017 RADIOLOGY
P5225
PROBST, JOSEPH JOHN, MD
1/4/2013
1/4/2018 RADIOLOGY
P1683
RAFIE, SHERVIN, MD
RAJKOWSKI, SAMUEL THOMAS,
TM00478 DO
12/15/2011 12/15/2016 RADIOLOGY
10/3/2011
10/3/2016 RADIOLOGY
RAO, ANURADHA T, MD
REISINGER, WILLIAM E, MD
RICHARDS, JOHN CALEB, MD
2/5/2010
5/29/2009
2/1/2012
2/5/2015 RADIOLOGY
5/29/2014 RADIOLOGY
2/1/2017 RADIOLOGY
P0123
RODRIGUEZ, VICTOR RAMON, MD
6/15/2011
6/15/2016 RADIOLOGY
P2773
ROSEBROCK, RICHARD ERIC, MD
4/2/2012
4/2/2017 RADIOLOGY
TM00369 RUDENSKY, DANIEL ELIEZER, MD
6/4/2010
6/4/2015 RADIOLOGY
SAFVI, AMJAD ALI, MD
SALDANA, DAVID ABRAM, MD
SAM, KENNY , DO
SARMIENTO, JORGE LUIS, MD
BODY IMAGING
ABDOMINAL
RADIOLOGY
4/1/2011
4/1/2016 RADIOLOGY
10/17/2011 10/17/2016 RADIOLOGY
N5352
N3269
P2056
N8059
P1924
P6911
P5467
BREAST IMAGING
INTERVENTIONAL
RADIOLOGY
WILMETTE
Registration
Status of
Practice
Texas
State
License
IL
N/A
2/5/2010 None
N/A
12/6/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
9/24/2010 None
12/17/2010 None
2/15/2011 None
N/A
N/A
N/A
3/15/2012 None
12/22/2011 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
10/11/2011 None
N/A
EDEN PRAIRIE MN
HOUSTON
TX
ACTIVE
ACTIVE
4/12/2011 None
10/31/2011 None
N/A
N/A
SAN ANTONIO TX
FORT SAM
HOUSTON
TX
ACTIVE
6/19/2012 None
N/A
ACTIVE
1/15/2013 None
N/A
ACTIVE
12/23/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
10/18/2011 None
N/A
2/5/2010 None
8/31/2009 None
2/9/2012 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
6/21/2011 None
N/A
4/2/2012 None
N/A
6/4/2010 None
N/A
MILWAUKEE
WI
BODY IMAGING
NUCLEAR MEDICINE
HOUSTON
TX
OLEAN
NY
NEURO-RADIOLOGY
10/29/2010 10/29/2015 RADIOLOGY
1/17/2012
1/17/2017 RADIOLOGY
6/3/2013
6/3/2018 RADIOLOGY
2/1/2013
2/1/2018 RADIOLOGY
HOUSTON
HOUSTON
EL PASO
Page 287 of 301
Disciplinary
Status Date
6/5/2012 None
ABDOMINAL
RADIOLOGY
TX
TX
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
10/29/2010
1/20/2012
6/25/2013
2/7/2013
None
None
None
None
N/A
N/A
N/A
N/A
License
Number
N4733
P1404
Physician Name
SELOUAN, ROGER RAYMOND, MD
SERLIN, SCOTT BENJAMIN, MD
TM00474 SHAH, HEMANT BHARAT, MD
edicaid
edicaid
End Date
Designated)
11/6/2009
11/4/2011
11/6/2014 RADIOLOGY
11/4/2016 RADIOLOGY
9/15/2011
9/15/2016 RADIOLOGY
N6652
SHAH, RAJVEE MANOJ, MD
6/4/2010
6/4/2015 RADIOLOGY
N5390
SHAHIN, ISLAM ALY, MD
2/5/2010
2/5/2015 RADIOLOGY
P1817
N6020
SHERWOOD, SCOT HAMILTON, MD
SHI, ANN ANG, MD
1/2/2012
4/9/2010
1/2/2017 RADIOLOGY
4/9/2015 RADIOLOGY
P3669
P7709
SKEENS, JOSEPH LESLIE, MD
SMITH, CAMERON , MD
6/15/2012
8/15/2013
6/15/2017 RADIOLOGY
8/15/2018 RADIOLOGY
TM00372 SOKOL, JOSHUA ROBERT, MD
P7857
SRINIVASAN, ASHMITHA, MD
6/4/2010
8/30/2013
6/4/2015 RADIOLOGY
8/30/2018 RADIOLOGY
N1178
TERRERI, ANTHONY ANDREW, MD
8/29/2008
8/29/2013 RADIOLOGY
P2168
TINUBU, SANYA, MD
2/10/2012
2/10/2017 RADIOLOGY
P3466
N4819
N2863
P4724
N9005
TRAORE, AMINATA , MD
VANCE, AWAIS ZAFAR, MD
VASEK, JAMES VENCIL JR, MD
VEIGH, STEPHEN, DO
VON RITSCHL, ANDREAS JOHANN,
MD
P1429
P5490
VON RITSCHL, RUDIGER H, MD
VUONG, CUONG TRI, MD
H4770
WADLINGTON, VAN R, MD
P2392
N6761
P7048
WAGERS, STEVEN A JR, MD
WALKIEWICZ, THOMAS WALTER,
MD
WELLS, DAVID LAWRENCE, MD
6/1/2012
6/1/2017
11/6/2009
11/6/2014
4/3/2009
4/3/2014
10/15/2012 10/15/2017
RADIOLOGY
RADIOLOGY
RADIOLOGY
RADIOLOGY
Secondary Specialty
(Self-Designated)
RADIOLOGY
RADIOLOGY
BREAST IMAGING
MILWAUKEE
WI
HOUSTON
TX
TEMPLE
TX
HOUSTON
TX
PROVIDENCE
TEMPLE
NEURO-RADIOLOGY NAPLES
TX
RI
TX
FL
GALVESTON
TX
PLANO
TX
BIRMINGHAM
AL
TACOMA
WA
CARLSBAD
NM
11/4/2011
2/1/2013
11/4/2016 RADIOLOGY
2/1/2018 RADIOLOGY
NEURO-RADIOLOGY
3/1/2012
3/1/2017 RADIOLOGY
6/4/2015 RADIOLOGY
6/14/2018 RADIOLOGY
ACTIVE
ACTIVE
RICHARDSON TX
NEURO-RADIOLOGY
6/4/2010
6/14/2013
TX
TX
INTERVENTIONAL
RADIOLOGY
3/1/2016 RADIOLOGY
3/1/2017 RADIOLOGY
HOUSTON
HOUSTON
PEDIATRIC
RADIOLOGY
3/1/2011
3/1/2012
Practice City
Registration
Status of
Practice
Texas
State
License
INTERVENTIONAL
RADIOLOGY
NEURORADIOLOGY
Page 288 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
1/27/2010 None
12/8/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/11/2011 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
1/13/2012 None
4/14/2010 None
N/A
N/A
6/15/2012 None
8/19/2013 None
N/A
N/A
6/4/2010 None
9/4/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
9/8/2008 None
N/A
2/10/2012 None
N/A
6/1/2012
11/16/2009
4/8/2009
11/22/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
TEXAS
LICENSE
ISSUED
4/13/2011 None
N/A
11/4/2011 None
2/5/2013 None
N/A
N/A
3/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
3/5/2012 None
N/A
6/4/2010 None
6/25/2013 None
N/A
N/A
License
Number
Physician Name
TM00523 WICHMAN, HEATHER JO, MD
edicaid
edicaid
End Date
Designated)
9/17/2012
9/17/2017 RADIOLOGY
10/17/2011 10/17/2016 RADIOLOGY
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
RADIOLOGY
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
PEDIATRIC
RADIOLOGY
BREAST IMAGING
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
P1249
WILLIAMS, GETHIN, MD
N7033
P5314
WILLIAMS, JENNIFER LYNN, MD
WINFORD, JUNE KRISTIN, MD
7/1/2010
1/15/2013
7/1/2015 RADIOLOGY
1/15/2018 RADIOLOGY
N7037
P6300
WORKMAN, JAMES LEONARD JR,
MD
YACTOR, AMY REBECCA, MD
7/1/2010
4/12/2013
7/1/2015 RADIOLOGY
4/12/2018 RADIOLOGY
P0685
YANG, CAROLINE , MD
8/1/2011
8/1/2016 RADIOLOGY
N6116
P7054
P6559
YOUNG, CATHERINE ALICE, MD
YU, FANG , MD
ZABAK, ELAINA M, MD
4/9/2010
6/14/2013
5/1/2013
4/9/2015 RADIOLOGY
6/14/2018 RADIOLOGY
5/1/2018 RADIOLOGY
N8476
ZAMIR, SYED SHAN, MD
1/3/2011
1/3/2016 RADIOLOGY
N6118
ZAMORA, JESUS GABRIEL, MD
4/9/2010
4/9/2015 RADIOLOGY
N9015
P0327
ZENOOZ, NAVID ALIYARI, MD
ZINK, WALTER EARL III, MD
3/1/2011
7/1/2011
P0002
ARCHER, JOHANNA SUZANNE
MUIR, MD
6/15/2011
P7010
NURUDEEN, SAHADAT KEMI, MD
6/14/2013
3/1/2016 RADIOLOGY
7/1/2016 RADIOLOGY
REPRODUCTIVE
ENDOCRINOLOGY
6/15/2016 AND INFERTILITY
REPRODUCTIVE
ENDOCRINOLOGY
6/14/2018 AND INFERTILITY
P5251
1/15/2013
INTERNAL MEDICINE
N9992
ABBAS, ZOHAIR, MD
ABOU KHAMIS, TAREQ ABDALLAH,
MD
6/15/2011
INTERNAL MEDICINE
N4266
P2415
P4848
AYALA GARCIA, LILLIAM ENID, MD
BARNES, JAMMIE KAY, MD
BEG, HUMAYUN, MD
N8171
CHEN, MING, MD
11/6/2009
3/15/2012
11/15/2012 11/15/2017 RHEUMATOLOGY
12/1/2010
Practice City
MILWAUKEE
Registration
Status of
Practice
Texas
State
License
WI
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/7/2012 None
N/A
10/17/2011 None
N/A
BOSTON
MA
ACTIVE
ACTIVE
7/13/2010 None
2/14/2013 None
N/A
N/A
MAUMELLE
DALLAS
AR
TX
ACTIVE
ACTIVE
7/13/2010 None
4/16/2013 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/26/2011 None
N/A
4/9/2010 None
6/20/2013 None
6/27/2013 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
2/9/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
ACTIVE
4/12/2011 None
7/7/2011 None
N/A
N/A
OBSTETRICS AND
GYNECOLOGY
LICENSE
ISSUED
6/15/2011 None
N/A
OBSTETRICS AND
GYNECOLOGY
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
6/14/2013 None
N/A
1/15/2013 None
N/A
6/15/2011 None
N/A
MUSCULOSKELETAL
IMAGING
HOUSTON
MAMMOGRAPHY
SAN ANTONIO TX
DALLAS
TX
INTERVENTIONAL
RADIOLOGY
NEURORADIOLOGY
MUSCULOSKELETAL PALM
RADIOLOGY
SPRINGS
CA
NEURO-RADIOLOGY SAN ANTONIO TX
OKLAHOMA
INTERNAL MEDICINE CITY
Page 289 of 301
TX
ACTIVE
ACTIVE
ACTIVE
12/7/2009 None
3/16/2012 None
11/20/2012 None
N/A
N/A
N/A
OK
ACTIVE
12/13/2010 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
N0749
N5679
EMEJUAIWE, NKECHINYERE , MD
FRANCIS, MARK LEE, MD
8/29/2008
4/9/2010
P7638
GOODMAN, OLGA, MD
8/15/2013
N5130
JHA, SWASTIKA, MD
2/5/2010
INTERNAL MEDICINE
P5092
KARIA, VIJAY, MD
12/17/2012 12/17/2017 RHEUMATOLOGY
INTERNAL MEDICINE
P5092
KARIA, VIJAY, MD
12/17/2012 12/17/2017 RHEUMATOLOGY
INTERNAL MEDICINE
P5092
KARIA, VIJAY, MD
12/17/2012 12/17/2017 RHEUMATOLOGY
INTERNAL MEDICINE
N8033
MALANI, SEEMA, MD
10/29/2010 10/29/2015 RHEUMATOLOGY
INTERNAL MEDICINE
N5223
N9905
N8041
P5686
MARTENS, HAL FREDRICK, DO
MCCALLUM, REX MONROE, MD
MICHAEL, ADRIAN A, MD
MIHU, RAMONA , MD
2/5/2010
6/3/2011
10/29/2010 10/29/2015 RHEUMATOLOGY
3/1/2013
P4600
N5968
N8141
NAJAM, FERHANA, MD
RESPICIO, GUADA REMUDARO,
MD
SAID, NUHA R, MD
N8721
P7855
N4759
SEHGAL, SUPRIYA, MD
SHPARAGO, NEAL IRA, DO
SMITH, KAREN DOROTHY , MD
2/4/2011
8/30/2013
11/6/2009
DALLAS
EL PASO
TX
TX
TX
P2540
N9969
P4619
P3471
N7506
SYEDA, UZMA AHMAD, MD
TARTER, LAURA, MD
THOMAS, ASHA J, MD
UCHIYAMA, ROBERT CALVIN, MD
VALICEK, RYAN ALAN, MD
3/15/2012
6/3/2011
10/1/2012
6/1/2012
8/16/2010
3/15/2017
6/3/2016
10/1/2017
6/1/2017
8/16/2015
INTERNAL MEDICINE
FORT WORTH
INTERNAL MEDICINE SUGARLAND
TX
TX
TX
TX
N6756
VIRK, ZIAULLAH , MD
N3437
ALONSO, WILFRED JEROME, MD
10/1/2012
4/9/2010
11/15/2010 11/15/2015 RHEUMATOLOGY
6/4/2010
8/21/2009
RHEUMATOLOGY
RHEUMATOLOGY
RHEUMATOLOGY
RHEUMATOLOGY
RHEUMATOLOGY
8/21/2014 SLEEP MEDICINE
INTERNAL MEDICINE SUGAR LAND
INTERNAL MED PEDS
HOUSTON
Registration
Status of
Practice
Texas
State
License
WICHITA
INTERNAL MEDICINE FALLS
TX
TX
ACTIVE
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
TX
TX
TX
TX
INTERNAL MEDICINE
PROVIDENCE RI
INTERNAL MEDICINE
FAMILY MEDICINE
Page 290 of 301
CALGARY,
ALBERTA TZY
4RZ
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/28/2008 None
4/28/2010 None
N/A
N/A
8/21/2013 None
N/A
2/5/2010 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
10/29/2010 None
N/A
2/5/2010
6/15/2011
11/4/2010
3/8/2013
None
None
None
None
N/A
N/A
N/A
N/A
10/2/2012 None
N/A
4/9/2010 None
12/10/2010 None
N/A
N/A
2/4/2011 None
9/4/2013 None
11/16/2009 None
N/A
N/A
N/A
3/15/2012
6/15/2011
11/14/2012
6/7/2012
8/19/2010
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
6/4/2010 None
N/A
9/9/2009 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N4947
L9462
N4227
BHADRIRAJU, SRINIVAS, MD
ROY, JAMES WILLIAM, MD
SINGH, HARAMANDEEP , MD
P3352
HUYNH, PHUONG NAM-THUY, MD
6/1/2012
N2407
BLUEITT, DAMOND , MD
4/3/2009
N3619
DIMEFF, ROBERT JOSEPH, MD
P4898
NWAEZE, IJEOMA O, MD
N5490
WRIGHT, JUSTIN MICHAEL, MD
P0523
YEO, ALBERT, MD
7/15/2011
P6588
BICKETT, MELISSA MAE, MD
5/15/2013
N2689
NGUYEN, TONY KIM , MD
4/3/2009
P2198
3/1/2012
P7193
BLACK, DALLIAH MASHON, MD
LAYEEQUR RAHMAN,
RAKHSHANDA , MD
RIVERS, AEISHA KEKHIA STIMAGE,
MD
N4049
ROURKE, LOREN LYNN, MD
P2283
P6937
WOOLDRIDGE, RACHEL DIANE, MD
P6643
N3883
HRANJEC, TJASA, MD
MCNUTT, MICHELLE KATHLEEN,
MD
N8723
SHAKE, JAY G, MD
N4276
BALCH, GLEN CHARLES, MD
2/5/2010
7/1/2013
11/6/2009
8/21/2009
11/15/2012
2/5/2010
3/1/2012
7/1/2013
8/21/2009
6/3/2013
5/15/2013
8/21/2009
2/4/2011
11/6/2009
6/1/2017 SPORTS MEDICINE
SPORTS MEDICINE
SPORTS MEDICINE
SPORTS MEDICINE
SPORTS MEDICINE
SPORTS MEDICINE
SPORTS MEDICINE
5/15/2018 (ORTH SURG)
SPORTS MEDICINE
4/3/2014 (ORTH SURG)
SURGICAL BREAST
3/1/2017 ONCOLOGY
SURGICAL BREAST
3/1/2017 ONCOLOGY
SURGICAL BREAST
7/1/2018 ONCOLOGY
SURGICAL BREAST
8/21/2014 ONCOLOGY
SURGICAL BREAST
6/3/2018 ONCOLOGY
SURGICAL CRITICAL
5/15/2018 CARE
SURGICAL CRITICAL
8/21/2014 CARE
SURGICAL CRITICAL
2/4/2016 CARE
SURGICAL
11/6/2014 ONCOLOGY
Secondary Specialty
(Self-Designated)
PULMONARY
CRITICAL CARE
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
PSYCHIATRY
HUNTSVILLE
SAN RAMON
AL
CA
LICENSE
ISSUED
ACTIVE
ACTIVE
FAMILY MEDICINE
CLEVELAND
OH
FAMILY MEDICINE
SPORTS MEDICINE
(FAMILY PRACTICE)
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
7/3/2013 None
11/19/2009 None
N/A
N/A
N/A
ACTIVE
6/13/2012 None
N/A
FORT WORTH TX
ACTIVE
4/24/2009 None
N/A
DALLAS
TX
ACTIVE
8/26/2009 None
N/A
MILWAUKEE
WI
ACTIVE
LICENSE
ISSUED
11/19/2012 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/20/2011 None
N/A
5/15/2013 None
N/A
FAMILY PRACTICE
ORTHOPEDIC
SURGERY
SAN ANTONIO TX
ORTHOPEDICS
CLEVELAND
OH
ACTIVE
4/29/2009 None
N/A
HOUSTON
TX
ACTIVE
3/16/2012 None
N/A
GENERAL SURGERY AMARILLO
TX
ACTIVE
3/5/2012 None
N/A
TX
ACTIVE
7/15/2013 None
N/A
HOUSTON
TX
ACTIVE
8/25/2009 None
N/A
DALLAS
TX
ACTIVE
6/10/2013 None
N/A
DALLAS
TX
ACTIVE
5/17/2013 None
N/A
HOUSTON
TX
ACTIVE
10/5/2009 None
N/A
TX
ACTIVE
2/14/2011 None
N/A
TX
ACTIVE
11/17/2009 None
N/A
SURGICAL
ONCOLOGY
TRAUMATIC
SURGERY
THORACIC SURGERY TEMPLE
ABDOMINAL
SURGERY
DALLAS
Page 291 of 301
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
N9679
BOLAND, GENEVIEVE MARIE, MD
5/16/2011
5/16/2016
P0018
CAVANESS, KEITH MICHAEL, DO
6/15/2011
6/15/2016
P3299
6/1/2012
6/1/2017
P7087
CHAI, CHRISTY YOON-HEE, MD
CHECKA, CRISTINA MARGARITA,
MD
7/1/2013
7/1/2018
P7090
CONRAD, CLAUDIUS, MD
7/1/2013
7/1/2018
P7262
COX, DERRICK DIONE, MD
7/15/2013
7/15/2018
P6602
DE ROSA, NICOLE, MD
5/15/2013
5/15/2018
N9062
HAYNES, ALEX BERNARD, MD
3/15/2011
3/15/2016
N5729
HILL, JOSHUA S, MD
4/9/2010
4/9/2015
N6371
HYNGSTROM, JOHN ROBERT, MD
6/4/2010
6/4/2015
N8210
LE VOYER, THOMAS EUGENE, MD
12/1/2010
12/1/2015
P5836
LILES, JOE SPENCER, MD
3/15/2013
3/15/2018
P3051
PAPAVASILIOU, PAVLOS , MD
5/1/2012
5/1/2017
H3514
ROH, MARK STEPHEN, MD
N3303
SHARIF, SUHAIL , MD
N4169
TRUTY, MARK JOSEPH, MD
P0692
AFTAB, MUHAMMAD , MD
N4891
AKAY, MEHMET HAKAN, MD
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
ONCOLOGY
SURGICAL
12/12/2008 12/12/2013 ONCOLOGY
SURGICAL
5/29/2009
5/29/2014 ONCOLOGY
SURGICAL
8/21/2009
8/21/2014 ONCOLOGY
THORACIC
CARDIOVASCULAR
8/15/2011
8/15/2016 SURGERY
THORACIC
CARDIOVASCULAR
2/5/2010
2/5/2015 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
1515
HOLCOMBE
GENERAL SURGERY BLVD
TRANSPLANT
SURGERY
Registration
Status of
Practice
Texas
State
License
TX
GENERAL SURGERY
BREAST ONCOLOGY NASSAU BAY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/19/2011 None
N/A
6/15/2011 None
N/A
6/1/2012 None
N/A
TX
ACTIVE
7/2/2013 None
N/A
TX
ACTIVE
7/31/2013 None
N/A
TX
ACTIVE
7/24/2013 None
N/A
TX
ACTIVE
6/13/2013 None
N/A
MA
ACTIVE
3/30/2011 None
N/A
TX
4/27/2010 None
N/A
GENERAL SURGERY
ACTIVE
LICENSE
ISSUED
6/4/2010 None
N/A
ACTIVE
12/10/2010 None
N/A
TX
ACTIVE
4/12/2013 None
N/A
TX
5/11/2012 None
N/A
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
3/12/2009 None
N/A
GENERAL SURGERY FT. WORTH
TX
ACTIVE
6/5/2009 None
N/A
TX
ACTIVE
9/17/2009 None
N/A
TX
ACTIVE
8/22/2011 None
N/A
2/5/2010 None
N/A
HOUSTON
GENERAL SURGERY EL PASO
HOUSTON
GENERAL SURGERY BOSTON
HOUSTON
HOUSTON
HOUSTON
GENERAL SURGERY
Page 292 of 301
LICENSE
ISSUED
License
Number
Physician Name
P7740
ARZOUMAN, DAVID ALLEN, MD
N6167
BECKLES, DANIEL LINCOLN, MD
N6846
CORNWELL, LORRAINE D, MD
N7539
FLORES, HECTOR ALEJANDRO,
MD
P6178
HARRINGTON, KATHERINE
BROOKS, MD
N4508
KARPINSKI, SYLWIA, MD
N3786
KERENDI, FARAZ, MD
P4976
LEE, KENNETH THOMAS, MD
P3549
LIMA, BRIAN, MD
P4991
OMER, SHUAB , MD
N8333
PAL, JAY DEEP, MD
P0864
PREVENTZA, OURANIA , MD
N8245
SINGHAL, ARUN K, MD
edicaid
edicaid
End Date
Designated)
THORACIC
CARDIOVASCULAR
8/30/2013
8/30/2018 SURGERY
THORACIC
CARDIOVASCULAR
6/4/2010
6/4/2015 SURGERY
THORACIC
CARDIOVASCULAR
7/1/2010
7/1/2015 SURGERY
THORACIC
CARDIOVASCULAR
8/27/2010
8/27/2015 SURGERY
THORACIC
CARDIOVASCULAR
4/12/2013
4/12/2018 SURGERY
THORACIC
CARDIOVASCULAR
11/6/2009
11/6/2014 SURGERY
THORACIC
CARDIOVASCULAR
8/21/2009
8/21/2014 SURGERY
THORACIC
CARDIOVASCULAR
11/30/2012 11/30/2017 SURGERY
THORACIC
CARDIOVASCULAR
6/8/2012
6/8/2017 SURGERY
THORACIC
CARDIOVASCULAR
11/30/2012 11/30/2017 SURGERY
THORACIC
CARDIOVASCULAR
12/15/2010 12/15/2015 SURGERY
THORACIC
CARDIOVASCULAR
8/26/2011
8/26/2016 SURGERY
THORACIC
CARDIOVASCULAR
12/1/2010
12/1/2015 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
TUCSON
Registration
Status of
Practice
Texas
State
License
AZ
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
9/9/2013 None
N/A
THORACIC SURGERY
LICENSE
ISSUED
6/4/2010 None
N/A
GENERAL SURGERY
LICENSE
ISSUED
7/1/2010 None
N/A
LICENSE
ISSUED
8/27/2010 None
N/A
LICENSE
ISSUED
4/12/2013 None
N/A
LICENSE
ISSUED
11/6/2009 None
N/A
GENERAL SURGERY
GENERAL SURGERY AUSTIN
TX
ACTIVE
8/27/2009 None
N/A
GENERAL SURGERY TEXARKANA
TX
ACTIVE
12/4/2012 None
N/A
TX
ACTIVE
6/19/2012 None
N/A
TX
ACTIVE
12/7/2012 None
N/A
AUSTIN
TRANSPLANT
SURGERY
LICENSE
ISSUED
12/15/2010 None
N/A
CRITICAL CARE
(SURGERY)
LICENSE
ISSUED
8/26/2011 None
N/A
12/13/2010 None
N/A
Page 293 of 301
LONGVIEW
TX
ACTIVE
License
Number
Physician Name
N1192
TSAI, PETER I-HSUAN, MD
N9838
CUELLAR, AUGUSTO, MD
P6157
DUVALL, LUCAS MAIER, MD
P7777
HELSEL, BRYAN SCOTT, MD
P6975
N7815
HILL, BRANDON ROBERT, MD
KAISER, LARRY ROBERT, MD
P7497
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
THORACIC
CARDIOVASCULAR
TRAUMATIC
8/29/2008
8/29/2013 SURGERY
SURGERY
VASCULAR
6/3/2011
6/3/2016 THORACIC SURGERY SURGERY
CARDIOVASCULAR
4/12/2013
CARDIOVASCULAR
8/30/2013
6/14/2013
10/1/2010
6/14/2018 THORACIC SURGERY
8/1/2013
P6458
MAKEY, IAN ANDREW, MD
MARTINEZ TORRES, CARLO OBET,
MD
5/1/2013
N2233
PARSONS, ALDEN MAIER, MD
N8567
ROBERTS, JOHN R, MD
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
SHREVEPORT LA
SALT LAKE
CITY
HOUSTON
UT
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
9/5/2008 None
N/A
6/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/24/2013 None
N/A
8/30/2013 None
N/A
6/25/2013 None
10/18/2010 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
8/6/2013 None
N/A
CARDIOVASCULAR
SURGERY
5/1/2013 None
N/A
2/6/2009
2/19/2009 None
N/A
1/18/2011
ACTIVE
LICENSE
ISSUED
1/18/2011 None
N/A
VASCULAR
SURGERY
CARDIOVASCULAR
SURGERY
ACTIVE
LICENSE
ISSUED
5/9/2011 None
N/A
2/4/2011 None
N/A
GENERAL PRACTICE
ACTIVE
9/19/2011 None
N/A
N9632
RODRIGUEZ, VICTOR M, MD
5/2/2011
N8729
SMITH, RONALD DOUGLAS JR, MD
2/4/2011
P1034
ZAMAN, TARIQ UZ, MD
9/15/2011
N1967
ZEHR, KENTON JAMES, MD
N1536
ASHAM, EMAD HAKEEM, MD
P0352
BYNON, JOHN STEVENSON JR, MD
P2627
N2093
DAR, WASIM AKRAM, MD
GORDON BURROUGHS,
SHERILYN, MD
P6660
KHAN, TARIQ NAWAZ, MD
P1688
ROFAIEL, GEORGE, MD
12/12/2008 12/12/2013 THORACIC SURGERY
TRANSPLANT
12/12/2008 12/12/2013 SURGERY
TRANSPLANT
7/15/2011
7/15/2016 SURGERY
TRANSPLANT
4/2/2012
4/2/2017 SURGERY
TRANSPLANT
2/6/2009
2/6/2014 SURGERY
TRANSPLANT
5/15/2013
5/15/2018 SURGERY
TRANSPLANT
12/15/2011 12/15/2016 SURGERY
TX
GENERAL SURGERY TEMPLE
TX
ACTIVE
3/4/2009 None
N/A
GENERAL SURGERY GALVESTON
TX
ACTIVE
1/2/2009 None
N/A
TX
ACTIVE
7/21/2011 None
N/A
GENERAL SURGERY ATLANTA
GA
ACTIVE
4/4/2012 None
N/A
TX
ABDOMINAL
SURGERY
FORT WORTH TX
ACTIVE
8/21/2009 None
N/A
ACTIVE
5/20/2013 None
N/A
GENERAL SURGERY SEATTLE
ACTIVE
3/2/2012 None
N/A
Page 294 of 301
WA
edicaid
edicaid
License
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
TRANSPLANT
N4090
SHEN, LUKE YU-PING, MD
8/21/2009
8/21/2014 SURGERY
GENERAL SURGERY
SURGICAL CRITICAL
N8483
AYDELOTTE, JAYSON DAVID, MD
1/18/2011
1/18/2016 TRAUMATIC SURGERY CARE
SURGICAL CRITICAL
N5604
CAPELLA, JEANNETTE MARIE, MD
4/9/2010
SURGICAL CRITICAL
N4039
RICO, FERDINAND REYES, MD
8/21/2009
SURGICAL CRITICAL
P6910
SALINAS, CYNTHIA MAE, MD
6/3/2013
CRITICAL CARE
N7763
WILLIAMS, BRIAN HENRY, MD
9/15/2010
9/15/2015 TRAUMATIC SURGERY (TRAUMA)
SURGICAL CRITICAL
N6797
ZONIES, DAVID , MD
6/4/2010
UNDERSEA AND
HYPERBARIC MED
P7421
DAVIS, LANCE LEE, MD
8/1/2013
8/1/2018 (PREV MED)
FAMILY MEDICINE
UNDERSEA AND
HYPERBARIC MED
N6124
GILMORE, LAURA SHANNON, MD
6/4/2010
6/4/2015 (PREV MED)
UNDERSEA
HYPERBARIC MED
P1528
CARPENTER, SHAUN ROBERT, MD
12/1/2011
12/1/2016 (EMER MED)
UNDERSEA
HYPERBARIC MED
N8006
FERRINI, VINCENT FRANK III, MD
10/29/2010 10/29/2015 (EMER MED)
P0361
N7266
N9618
CLOS, AUDRA LEA, MD
GONZALEZ GIBLER, DAVID
PATRICIO, MD
OLSEN, ALEX BRYAN, MD
N5074
GEORGIOU, KIM D, MD
P3179
KIRBY, JAMIE ELLEN, MD
5/15/2012
P7680
NAIR, RINSY, MD
8/15/2013
N4986
CHOW, JOSEPH LIN YUN, MD
P4608
RAMSEY, PAMELA MCVEY, MD
7/15/2011
8/2/2010
5/2/2011
2/5/2010
2/5/2010
10/1/2012
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
9/30/2009 None
N/A
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
1/28/2011 None
N/A
4/9/2010 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
9/8/2009 None
N/A
MCALLEN
TX
ACTIVE
7/8/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
9/20/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
8/5/2013 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
12/8/2011 None
N/A
10/29/2010 None
N/A
7/15/2011 None
N/A
9/6/2010 None
5/9/2011 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
5/23/2012 None
N/A
ACTIVE
LICENSE
ISSUED
8/26/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
10/3/2012 None
N/A
CHARLESTON SC
COVINGTON
LA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
UNSPECIFIED
FAMILY MEDICINE
TYLER
TX
FAMILY PRACTICE
EMERGENCY
MEDICINE
Page 295 of 301
Disciplinary
Status Date
SAN ANTONIO TX
7/15/2016 UNSPECIFIED
URGENT CARE 2/5/2015 FAMILY PRACTICE
URGENT CARE
2/5/2015 MEDICINE
URGENT CARE
10/1/2017 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANGELO
TX
License
Number
P3675
P0017
N5283
Physician Name
THOMPSON, BOBBYE JO, MD
CASIANO, ELIZABETH RAMIREZ,
MD
edicaid
edicaid
Start Date
End Date
Designated)
(Self-Designated)
URGENT CARE
6/15/2012
6/15/2017 MEDICINE
DERMATOLOGY
GYNECOLOGIC
6/15/2011
6/15/2016 UROGYNECOLOGY
SURGERY
OBSTETRICS AND
2/5/2010
GYNECOLOGY
N7746
NGUYEN, AIMEE LE, MD
SAMUELS, TERRI-ANN PATRICIA,
MD
P4448
GODOY, GUILHERME , MD
9/17/2012
UROLOGIC
9/17/2017 ONCOLOGY
H5696
P2108
N9192
CAMMACK, JAMES THOMAS, MD
CHU, LEI, MD
COLEN, JOHN SHERMAN, MD
7/15/2010
2/10/2012
4/1/2011
UROLOGIC
7/15/2015 UROLOGIC SURGERY ONCOLOGY
2/10/2017 UROLOGIC SURGERY
4/1/2016 UROLOGIC SURGERY UROLOGY
P0719
DESOUZA, ROWENA ANNE, MD
8/15/2011
P4749
DHANANI, NADEEM NIZAR, MD
11/1/2012
N5665
EKERUO, WESLEY , MD
N0752
ESPINOZA, MANUEL GEORGE, MD
P4952
N9713
P0604
P3004
P0236
P0252
FRIEBEN, RYAN WILLIAM, MD
HEY, WAYNE DAVID, DO
HINH, PETER , MD
HOU, JACK CHENG-TSUNG, MD
JENSEN, BURKITT WILLIAM, MD
MAMMEN, TONY, MD
P0100
MOORE, KENNETH PAGE, MD
6/15/2011
N6549
OLWENY, EPHREM ODOY, MD
6/4/2010
9/15/2010
UROLOGY
UROLOGIC
4/9/2010
8/29/2008
11/30/2012 11/30/2017 UROLOGIC SURGERY UROLOGIC SURGERY
5/16/2011
8/1/2011
5/1/2012
5/1/2017 UROLOGIC SURGERY UROGYNECOLOGY
7/1/2011
7/1/2011
P1380
OST, LOREN BARRETT, MD
11/4/2011
P7343
P7344
P6526
P7572
RODRIGUEZ, RONALD , MD
ROSEMAN, JOHN TYLER II, MD
SMITH, PAUL JOSEPH, MD
SMITH, WILLIAM ALFRED JR, MD
7/15/2013
7/15/2013
5/1/2013
8/1/2013
Practice City
GALVESTON
Registration
Status of
Practice
Texas
State
License
TX
SAN ANTONIO TX
Disciplinary
Status Date
ACTIVE
6/19/2012 None
N/A
ACTIVE
LICENSE
ISSUED
6/20/2011 None
N/A
2/5/2010 None
N/A
HOUSTON
TX
ACTIVE
9/28/2010 None
N/A
HOUSTON
TX
ACTIVE
N/A
LUBBOCK
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
9/28/2012 None
UNDER
BOARD
7/26/2010 ORDER
2/14/2012 None
4/8/2011 None
8/15/2011 None
N/A
11/28/2012 None
N/A
4/9/2010 None
N/A
9/8/2008 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
HARLINGEN
TX
ACTIVE
HOUSTON
FORT WORTH
HOUSTON
DALLAS
HUMBLE
ARLINGTON
TX
TX
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/31/2012
5/24/2011
8/8/2011
5/3/2012
7/6/2011
7/12/2011
UROLOGIC
Page 296 of 301
Registration
Status Date
Disciplinary
Status of
Texas
License
SULPHUR
SPRINGS
TX
ACTIVE
SAN ANTONIO
LONGVIEW
DALLAS
IRVING
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/1/2010
N/A
N/A
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
6/15/2011 None
N/A
6/4/2010 None
N/A
11/17/2011 None
N/A
7/22/2013
8/5/2013
5/6/2013
8/27/2013
None
None
None
None
N/A
N/A
N/A
N/A
License
Number
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
N9648
Physician Name
SPECK, MICHAEL CHRISTOPHER,
MD
N8731
P3248
STAMATAKIS, LAMBROS , MD
STEWART, JULIE NICOLE, MD
2/4/2011
5/15/2012
N7004
P6533
N9796
N1238
STILES, WILLIAM FREMONT III, DO
TAUSCH, TIMOTHY JAMES, MD
YOUNG, DIANE B, MD
ZAUSMER, GLENN DUANE, DO
7/1/2010
5/1/2013
5/16/2011
8/29/2008
7/1/2015
5/1/2018
5/16/2016
8/29/2013
N2935
BAUM, LAWRENCE OWEN III, MD
5/29/2009
5/29/2014 UROLOGY
P3509
P0170
BHAVSAR, ROBIN RASHMI, MD
BOOTWALA, YASMIN I, MD
6/8/2012
7/1/2011
6/8/2017 UROLOGY
7/1/2016 UROLOGY
UROLOGIC SURGERY
N9435
P7615
BRANTLY, ELISA KATHLEEN, MD
CARMEL, MAUDE, MD
4/15/2011
8/15/2013
4/15/2016 UROLOGY
8/15/2018 UROLOGY
UROLOGIC SURGERY
N6214
CHAPIN, BRIAN FRANCIS, MD
6/4/2010
6/4/2015 UROLOGY
N5643
N7078
P7096
CRONE, MICHAEL ROSS, MD
DEROSA, CHAD ALEN, MD
DHIR, ROHIT ROBERT, MD
4/9/2010
7/15/2010
7/1/2013
4/9/2015 UROLOGY
7/15/2015 UROLOGY
7/1/2018 UROLOGY
N5018
N8645
DILLON, BENJAMIN ETHAN, MD
EISENBERG, LAUREN N, DO
2/5/2010
2/4/2011
2/5/2015 UROLOGY
2/4/2016 UROLOGY
P4958
GOLDFARB, DAVID WOLFF, MD
K3211
GRABER, WILLIAM JAMES IV, MD
P1320
HAMMOND, GAINES JR, MD
P6638
N7627
5/2/2011
Practice City
Registration
Status of
Practice
Texas
State
License
UROLOGIC SURGERY
UROLOGIC SURGERY UNSPECIFIED
UROLOGIC SURGERY UROLOGY
UROLOGIC SURGERY
11/30/2012 11/30/2017 UROLOGY
2/5/2010
2/5/2015 UROLOGY
11/4/2011
11/4/2016 UROLOGY
HOUSTON
TX
TYLER
DALLAS
TX
TX
ABILENE
TX
UROLOGIC SURGERY HOUSTON
TX
HOUSTON
TX
DALLAS
TX
UROLOGIC
ONCOLOGY
EL PASO
HOUSTON
TX
TX
EL PASO
TX
UROLOGIC SURGERY
TX
TX
UROLOGIC
ONCOLOGY
5/15/2013
9/1/2010
5/15/2018 UROLOGY
9/1/2015 UROLOGY
P0747
HOANG, AN NGOC, MD
KHAVARI, ROSE , MD
KRESSIN, MARGARITA ROSENDO,
MD
8/15/2011
8/15/2016 UROLOGY
UROLOGIC SURGERY
N6479
MARVIN, ANDREA STEPHANIE, MD
6/4/2010
6/4/2015 UROLOGY
UROLOGIC SURGERY
Page 297 of 301
WACO
TX
SUGAR LAND
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
ACTIVE
5/10/2011 None
N/A
2/4/2011 None
6/18/2012 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/15/2010
5/2/2013
5/20/2011
9/15/2008
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/26/2009 None
N/A
6/8/2012 None
7/6/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
4/21/2011 None
8/20/2013 None
N/A
N/A
6/4/2010 None
N/A
4/9/2010 None
7/20/2010 None
7/3/2013 None
N/A
N/A
N/A
2/5/2010 None
2/14/2011 None
N/A
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
12/6/2012 None
N/A
2/5/2010 None
N/A
11/4/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/6/2013 None
11/3/2010 None
N/A
N/A
8/15/2011 None
N/A
6/4/2010 None
N/A
License
Number
N9267
Physician Name
MESSER, JAMIE CHRISTOPHER,
MD
N3192
MORRIS, BERNARD DAVID JR, MD
edicaid
edicaid
End Date
Designated)
4/1/2011
4/1/2016 UROLOGY
5/29/2009
5/29/2014 UROLOGY
Secondary Specialty
(Self-Designated)
UROLOGIC
ONCOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/28/2009 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
ACTIVE
4/29/2013 None
4/22/2013 None
N/A
N/A
TX
ACTIVE
7/12/2011 None
N/A
UROLOGIC SURGERY
ACTIVE
10/26/2009 None
N/A
UROLOGIC SURGERY ROUND ROCK TX
UROLOGIC
ONCOLOGY
HOUSTON
TX
ACTIVE
1/2/2012 None
N/A
ACTIVE
ACTIVE
10/24/2012 None
3/21/2011 None
N/A
N/A
UROLOGIC SURGERY PANAMA CITY FL
ACTIVE
6/13/2011 None
N/A
KILLEEN
TX
N6526
NAVAI, NEEMA , MD
6/4/2010
6/4/2015 UROLOGY
UROLOGIC
ONCOLOGY
N6530
NELIUS, THOMAS , MD
6/4/2010
6/4/2015 UROLOGY
UROLOGIC SURGERY
P6226
P6228
NEW, AARON ROBERT, MD
NGO, TIN CHAN, MD
4/12/2013
4/12/2013
4/12/2018 UROLOGY
4/12/2018 UROLOGY
UROLOGIC SURGERY
P0271
PEARSON, MATTHEW DEAN, MD
7/1/2011
7/1/2016 UROLOGY
N3993
8/21/2009
8/21/2014 UROLOGY
P1682
PHAM, DUNG QUOC, MD
POLNASZEK, NATHANIEL
MICHAEL, MD
12/15/2011 12/15/2016 UROLOGY
P4694
N8973
PORTEN, SIMA PRABODH, MD
RAJAMAHANTY, SRINIVAS, MD
10/15/2012 10/15/2017 UROLOGY
3/1/2011
3/1/2016 UROLOGY
J1761
RAMOS, CARLOS E, MD
P5123
RINARD, KATHERINE LEIGH, MD
12/17/2012 12/17/2017 UROLOGY
UROLOGIC SURGERY LUBBOCK
TX
ACTIVE
12/20/2012 None
N/A
P5123
12/17/2012 12/17/2017 UROLOGY
TX
ACTIVE
12/20/2012 None
N/A
P5123
12/17/2012 12/17/2017 UROLOGY
TX
ACTIVE
LICENSE
ISSUED
12/20/2012 None
N/A
N6984
SANDER, JAMES CHRISTOPHER,
MD
7/1/2010 None
N/A
H2964
P5728
SECREST, CHARLES LLOYD, MD
SIMHAN, JAY, MD
P5733
SRESHTA, JOSEPH NICHOLAS, MD
STERENCHOCK, TRENT DOUGLAS,
MD
P3456
N8858
N8994
STIKE, AARON BRONDELL, MD
SUBRAMANIAN, VAIRAVAN
SARAVANAN JR, MD
6/3/2011
6/3/2016 UROLOGY
7/1/2010
7/1/2015 UROLOGY
8/29/2008
3/1/2013
8/29/2013 UROLOGY
3/1/2018 UROLOGY
3/1/2013
3/1/2018 UROLOGY
6/1/2012
6/1/2017 UROLOGY
2/15/2011
2/15/2016 UROLOGY
3/1/2011
3/1/2016 UROLOGY
HOUSTON
UROLOGIC SURGERY AUSTIN
UROLOGIC SURGERY JACKSON
DALLAS
MS
TX
ACTIVE
ACTIVE
9/5/2008 None
3/11/2013 None
N/A
N/A
GALVESTON
TX
ACTIVE
3/6/2013 None
N/A
BEAUMONT
TX
ACTIVE
LICENSE
ISSUED
6/5/2012 None
N/A
2/15/2011 None
N/A
3/9/2011 None
N/A
FORT WORTH TX
Page 298 of 301
ACTIVE
License
Number
Physician Name
N8584
TARRY, SUSAN ELIZABETH, MD
N3342
TERLECKI, RYAN PATRICK, MD
edicaid
edicaid
End Date
Designated)
1/18/2011
1/18/2016 UROLOGY
5/29/2009
5/29/2014 UROLOGY
N6728
N8157
TSENG, TIMOTHY YU-TING, MD
WHITMAN, ERIC JASON, MD
P3486
WILLIS, DANIEL LEVI, MD
6/1/2012
N9331
WILTZ, AIMEE LORELEI, MD
4/1/2011
P4711
SHAW, CATHRYN JOHNSON, MD
P2390
VAYUVEGULA, SATISH VENKATA,
MD
P2932
WHITE, JEFFERY, MD
Secondary Specialty
(Self-Designated)
6/4/2010
6/4/2015 UROLOGY
11/15/2010 11/15/2015 UROLOGY
10/15/2012
3/1/2012
4/13/2012
6/1/2017 UROLOGY
4/1/2016 UROLOGY
VASCULAR AND
INTERVENTIONAL
VASCULAR AND
INTERVENTIONAL
3/1/2017 RADIOLOGY
VASCULAR AND
INTERVENTIONAL
4/13/2017 RADIOLOGY
VASCULAR AND
INTERVENTIONAL
5/29/2014 RADIOLOGY
Practice City
GALVESTON
DALLAS
FORT HOOD
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/21/2011 None
N/A
6/4/2009 None
N/A
6/4/2010 None
1/12/2011 None
N/A
N/A
6/8/2012 None
N/A
4/1/2011 None
N/A
ACTIVE
10/26/2012 None
N/A
ACTIVE
LICENSE
ISSUED
DIAGNOSTIC
RADIOLOGY
DALLAS
EMERGENCY
MEDICINE
ORLAND PARK IL
ACTIVE
4/5/2012 None
N/A
DIAGNOSTIC
RADIOLOGY
WACO
TX
ACTIVE
4/17/2012 None
N/A
AUSTIN
TX
ACTIVE
6/10/2009 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
2/12/2013 None
N/A
7/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
1/22/2010 None
N/A
8/30/2013 None
N/A
5/19/2011 None
N/A
1/4/2013 None
N/A
8/5/2010 None
SEE
PREVIOUS
9/8/2010 ORDER
N/A
DIAGNOSTIC
RADIOLOGY
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
N3389
WILLIAMSON, JOHN ANDREW, MD
5/29/2009
P5565
RODRIGUEZ, GUSTAVO JOSE, MD
2/8/2013
P0488
SANGHA, NAVDEEP SINGH, MD
7/15/2011
VASCULAR
2/8/2018 NEUROLOGY
VASCULAR
7/15/2016 NEUROLOGY
N4243
AL-KHOURY, GEORGES ELIE, MD
11/6/2009
11/6/2014 VASCULAR SURGERY GENERAL SURGERY PITTSBURGH
P7739
ANDACHEH, IDEN DAVID, MD
8/30/2013
N9680
BRINTON, MILTON HARVEY, MD
5/16/2011
8/30/2018 VASCULAR SURGERY GENERAL SURGERY
ADMINISTRATIVE
5/16/2016 VASCULAR SURGERY MEDICINE
SPRING
P5160
BUSKEN, CHRISTOPHER JOHN, MD
1/4/2013
N7235
CALDERIN, JULIO ANGEL, MD
N7529
N3551
TX
PA
TX
TX
8/2/2010
1/4/2018 VASCULAR SURGERY GENERAL SURGERY DALLAS
SULPHUR
8/2/2015 VASCULAR SURGERY GENERAL SURGERY SPRINGS
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
CARUSO, JOSEPH MICHAEL, MD
8/27/2010
8/27/2015 VASCULAR SURGERY GENERAL SURGERY ARLINGTON
TX
ACTIVE
CHEEMA, ZULFIQAR FAISAL , MD
8/21/2009
Page 299 of 301
ACTIVE
9/30/2009 None
8/30/2010
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
N7243
CHUNG, JAYER, MD
8/2/2010
TX
ACTIVE
8/5/2010 None
N/A
N2449
COOK, PATRICK RUSSELL, DO
4/3/2009
4/3/2014 VASCULAR SURGERY GENERAL SURGERY EL PASO
TX
ACTIVE
5/21/2009 None
N/A
P5352
COPELAND, DANIEL REID, MD
2/1/2013
2/6/2013 None
N/A
P4865
FAYAD, ZIAD YOUSSEF, MD
11/15/2012 None
N/A
P7441
GALINANES, EDGAR LUIS, MD
8/1/2013
GENERAL VASCULAR
8/1/2018 VASCULAR SURGERY SURGERY
8/1/2013 None
N/A
N5687
GHOSHEH, BASHAR, MD
4/9/2010
4/9/2010 None
N/A
P5182
GONZALEZ, LORENA , MD
1/4/2013
1/4/2018 VASCULAR SURGERY GENERAL SURGERY HOUSTON
1/28/2013 None
N/A
N8021
KEYHANI, ARASH , DO
10/29/2010 None
N/A
P3368
N7138
KNOWLES, MARTYN , MD
MARROCCO, CHRISTOPHER
JULIAN, MD
7/15/2010
P1106
MEKA, MADHAVI, MD
10/3/2011
10/3/2016 VASCULAR SURGERY GENERAL SURGERY BEDFORD
P5423
MILLER, TYRONE JOSEPH, DO
G6576
MYERS, STUART IRA, MD
6/14/2013
GENERAL VASCULAR
6/14/2018 VASCULAR SURGERY SURGERY
LINCOLN
N7567
ORTEGA, RAUL ENRIQUE, MD
8/27/2010
8/27/2015 VASCULAR SURGERY GENERAL SURGERY DENTON
P0667
RIZVI, SYED ZULFIQAR HYDER, MD
8/1/2011
8/1/2016 VASCULAR SURGERY
P3439
SAQIB, NAVEED USMAN, MD
6/1/2012
P3448
SHALHUB, SHERENE, MD
6/1/2012
6/1/2017 VASCULAR SURGERY
P7353
SINGLETON, TERRELL ANN, MD
7/15/2013
N4116
SMITH, SUMONA VERSIE , MD
8/21/2009
Page 300 of 301
ACTIVE
LICENSE
ISSUED
11/15/2012 11/15/2017 VASCULAR SURGERY GENERAL SURGERY
LICENSE
ISSUED
LICENSE
ISSUED
TX
10/29/2010 10/29/2015 VASCULAR SURGERY GENERAL SURGERY
6/1/2012
2/1/2013
TX
ACTIVE
LICENSE
ISSUED
6/7/2012 None
N/A
7/15/2010 None
N/A
ACTIVE
11/2/2011 None
N/A
ACTIVE
2/22/2013 None
N/A
NE
ACTIVE
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/20/2013 None
SEE
PREVIOUS
9/10/2010 ORDER
TX
HOUSTON
ACTIVE
LICENSE
ISSUED
TX
TX
8/30/2010
8/1/2011 None
N/A
6/1/2012 None
N/A
ACTIVE
6/12/2012 None
N/A
ACTIVE
7/17/2013 None
N/A
ACTIVE
9/14/2009 None
N/A
License
Number
Physician Name
edicaid
edicaid
End Date
Designated)
Secondary Specialty
(Self-Designated)
Page 301 of 301
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date

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