Listed by Name - 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 name.
License
Number
Physician Name
N1505
AASHISH, ANUNAYA , MD
N1507
Medicare/Me Medicare/Me
dicaid
dicaid
Agreement
Agreement Primary Specialty (Self- Secondary Specialty
Start Date
End Date
Designated)
(Self-Designated)
12/12/2008
12/12/2013 INTERNAL MEDICINE HOSPITALIST
12/12/2008
P2817
N4228
ABALIHI, CAROL NGOZI, MD
ABANG-HAYES, SARAH NICOLE,
MD
ABANTO, PEDRO RUBEN , MD
H9291
ABATI, ANDREA D, MD
12/15/2011
P1839
ABAWI, LAILAH MARIE, DO
P6758
ABBARA, SUHNY, MD
6/3/2013
P5251
ABBAS, ZOHAIR, MD
1/15/2013
N8262
P4536
ABBASI, ARSHAD ABID, MD
ABBASI, NADIA HAFEEZ, MD
N4873
N3410
N6801
ABBATE, ROBERT , DO
ABBOUD, LUCIEN NAJI, MD
ABDELGAWAD, AMR MOHAMMED
ATEF, MD
N7898
ABDELHADI, RUBA, MD
4/13/2012
11/6/2009
1/17/2012
12/15/2010
10/1/2012
2/5/2010
8/21/2009
7/1/2010
10/15/2010
12/12/2013 INTERNAL MED - PEDS
4/13/2017 FAMILY MEDICINE
11/6/2014 INTERNAL MEDICINE
DERMATOPATHOLOG
12/15/2016 Y
CYTOPATHOLOGY
EMERGENCY
1/17/2017 MEDICINE
CARDIOTHORACIC
6/3/2018 RADIOLOGY
RADIOLOGY
1/15/2018 RHEUMATOLOGY
PULMONARY
12/15/2015 MEDICINE
ORTHOPEDIC
7/1/2015 SURGERY
PEDIATRIC
GASTROENTEROLOG
10/15/2015 Y
Practice City
GAINESVILLE
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
EL PASO
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/30/2008 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
12/22/2008 None
N/A
4/13/2012 None
11/27/2009 None
N/A
N/A
ROCKVILLE
LOCUM
TENENS
MD
ACTIVE
12/20/2011 None
N/A
OH
ACTIVE
1/30/2012 None
N/A
BOSTON
MA
ACTIVE
LICENSE
ISSUED
6/7/2013 None
N/A
1/15/2013 None
N/A
1/5/2011 None
10/25/2012 None
N/A
N/A
2/5/2010 None
9/1/2009 None
N/A
N/A
INTERNAL MEDICINE
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
CARDIOLOGY
PEDIATRIC
ORTHOPEDICS
EL PASO
TX
ACTIVE
7/21/2010 None
N/A
PEDIATRICS
SAN ANTONIO TX
ACTIVE
10/27/2010 None
N/A
Page 1 of 300
License
Number
N4875
P0328
P7055
P1954
N1510
N1511
N7044
P6119
Physician Name
ABDEL-HALIM, AYMAN MOHAMED
MAMDOUH, MD
ABDELMOULA, MOHAMED MAHDY,
MD
ABDEL-REHIM, MOHAMED SABER,
MD
ABDUL, OLUMUYIWA ADEGBENGA,
MD
ABDULLA, CEDELA , MD
ABDULLA, ZAINAB , MD
ABEDI, GELAREH, MD
dicaid
dicaid
Agreement
Agreement Primary Specialty (SelfStart Date
End Date
Designated)
2/5/2010
2/5/2015 ANESTHESIOLOGY
7/15/2011
7/1/2013
2/1/2012
12/12/2008
12/12/2008
7/15/2010
2/1/2017
12/12/2013
12/12/2013
7/15/2015
Practice City
PAIN MANAGEMENT
HOUSTON
FAMILY MEDICINE
PSYCHIATRY
FAMILY MEDICINE
INTERNAL MEDICINE
OPHTHALMOLOGY
4/12/2013
N9992
N3415
ABID, HUMAIRA -, MD
ABOU KHAMIS, TAREQ ABDALLAH,
MD
ABRAHAM, ASHA , DO
6/15/2011
8/21/2009
P2819
P6306
N2355
P4730
ABRAHAM, GEORGE , MD
ABRAHAM, JENSON, MD
ABRAHAM, REENI ANN, MD
ABRAHAM, SAM S, MD
4/13/2012
5/1/2013
4/3/2009
11/1/2012
4/13/2017
5/1/2018
4/3/2014
11/1/2017
PH00002 ABRAMSKY, MITCHEL JAY, MD
5/29/2009
5/29/2014
P7234
ABUELEM, TAREK , MD
7/15/2013
7/15/2018
N7770
ABU-HIJLEH, MUHANNED A, MD
10/1/2010
10/1/2015
P7235
ABUNASSER, JAFAR JAMIL, MD
7/15/2013
7/15/2018
N4877
ACEVEDO, SARAH AMANDA, MD
2/5/2010
N4231
ACHOR, TIMOTHY STUART, MD
11/6/2009
2/5/2015 PEDIATRICS
ORTHOPEDIC
11/6/2014 TRAUMA
P0691
ACKLIN, JOY DEANN, DO
ACOSTA LARA, MARIA DEL PILAR,
MD
8/15/2011
8/15/2016 GENERAL PRACTICE
4/2/2012
P2568
Secondary Specialty
(Self-Designated)
FAMILY MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
GENERAL
PREVENTIVE
MEDICINE
NEUROLOGICAL
SURGERY
PULMONARY
CRITICAL CARE
MEDICINE
PULMONARY
MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
2/5/2010 None
N/A
ACTIVE
8/5/2011 None
N/A
SAN ANTONIO TX
ACTIVE
7/16/2013 None
N/A
CLEVELAND
HOUSTON
AUSTIN
SAN ANTONIO
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
2/3/2012
1/27/2009
1/28/2009
7/20/2010
None
None
None
None
N/A
N/A
N/A
N/A
4/12/2013 None
N/A
6/15/2011 None
8/28/2009 None
UNDER
BOARD
4/13/2012 ORDER
5/8/2013 None
4/21/2009 None
11/5/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
8/12/2009 None
N/A
7/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/5/2010 None
N/A
7/15/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
11/20/2009 None
N/A
ACTIVE
8/29/2011 None
N/A
ACTIVE
4/4/2012 None
N/A
OH
TX
TX
TX
FORT WORTH TX
DALLAS
TX
BURLESON
TX
HOUSTON
TX
PROVIDENCE RI
HOUSTON
TX
GENERAL SURGERY
Page 2 of 300
Disciplinary
Status Date
TX
INTERNAL MEDICINE
SLEEP MEDICINE
CRITICAL CARE
MEDICINE (IM)
Registration
Status Date
Disciplinary
Status of
Texas
License
GALVESTON
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
4/13/2012
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N2896
ACOSTA, INDRANI ENID, MD
5/29/2009
N9016
3/15/2011
P2567
ACOSTA, OMETEOTL MIGUEL, MD
ACOSTA, VERONICA DEL
SOCORRO, MD
P3602
ACUN, CEYDA, MD
6/15/2012
N9993
P4403
ADAMS, BENJAMIN DONALD, DO
ADAMS, GRETCHEN MAY, MD
6/15/2011
9/17/2012
N8601
ADAMS, JIMMY GLENN, DO
N7384
ADAMS, NEAL A, MD
P1955
P5916
ADAMS, TAJ CORDELL, MD
ADAPA, SREEDHAR REDDY, MD
2/1/2012
4/1/2013
P5582
3/1/2013
N2897
N7985
ADEBO, DILACHEW ACHIKO, MD
ADEBOGUN, OLADELE ADEPITAN,
MD
ADEDIJI, FAUSAT ABIDEMI, MD
ADEFEYISAN, SAMUEL ADEKUNLE,
MD
ADEJANA, ADEGBOYEGA
IBUKUNOLU, MD
ADELEYE, VICTORIA M, MD
5/29/2009
10/29/2010
N4232
ADENIYI, MUNIRU OLAKUNLE , MD
11/6/2009
P2939
ADEOYE, MARTINS ADEMOLA, MD
5/1/2012
N4233
ADERINBOYE, OMOLARA VIOLET,
MD
11/6/2009
P5019
ADESANYA, ISMAIL OLAYINKA, MD
12/17/2012
N6128
P4404
N7196
4/2/2012
2/4/2011
8/16/2010
6/4/2010
9/17/2012
8/2/2010
5/29/2014 NEUROLOGY
OBSTETRICS &
GYNECOLOGICAL
3/15/2016 SURGERY
HOUSTON
TX
ACTIVE
6/10/2009 None
N/A
MATERNAL AND
FETAL MEDICINE
SAN ANTONIO TX
ACTIVE
3/18/2011 None
N/A
DALLAS
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
4/27/2012 None
N/A
6/15/2012 None
N/A
6/15/2011 None
9/19/2012 None
N/A
N/A
2/4/2011 None
N/A
Practice City
TX
PEDIATRICS
PAMPA
TX
NEONATAL2/4/2016 PERINATAL MEDICINE PEDIATRICS
8/16/2015 OPHTHALMOLOGY
EMERGENCY
2/1/2017 MEDICINE
4/1/2018 NEPHROLOGY
PEDIATRICS,
3/1/2018 CARDIOLOGY
6/4/2015 PSYCHIATRY
9/17/2017 PEDIATRICS
PEDIATRIC ANES
8/2/2015 (PEDS)
OBSTETRICS AND
5/29/2014 GYNECOLOGY
CHILD AND
ADOLESCENT
5/1/2017 PSYCHIATRY
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Secondary Specialty
(Self-Designated)
VASCULAR
NEUROLOGY
4/2/2017 PEDIATRICS
6/15/2017 NEONATOLOGY
EMERGENCY
6/15/2016 MEDICINE
9/17/2017 FAMILY PRACTICE
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
OPHTHALMOLOGY VITREOUS SURGERY EL PASO
TX
ACTIVE
8/19/2010 None
N/A
ATLANTA
INTERNAL MEDICINE GAINESVILLE
GA
TX
ACTIVE
ACTIVE
2/7/2012 None
4/5/2013 None
N/A
N/A
3/5/2013 None
N/A
6/4/2010 None
11/8/2012 None
N/A
N/A
PHILADELPHIA PA
SHAWNEE
OK
ACTIVE
LICENSE
ISSUED
ACTIVE
PEDIATRIC CRITICAL
CARE MEDICINE
COLUMBIA
MO
ACTIVE
8/23/2010 None
N/A
BALTIMORE
MD
ACTIVE
ACTIVE
10/21/2009 None
11/4/2010 None
N/A
N/A
BAY CITY
TX
ACTIVE
1/20/2010 None
N/A
5/1/2012 None
N/A
11/11/2009 None
N/A
12/17/2012 None
N/A
NEPHROLOGY
LICENSE
ISSUED
PSYCHIATRY
PEDIATRIC
11/6/2014 INFECTIOUS DISEASE HOSPITALIST
FAMILY PRACTICE 12/17/2017 FAMILY MEDICINE
EMERGENCY MED
Page 3 of 300
LAREDO
TX
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5019
12/17/2012
P5019
ADETONA, OLUTOLA OLUGBENGA,
MD
12/17/2012
N1971
P5253
P5152
ADEYEFA, BABATUNDE , MD
ADEYEFA, OLUDAYO ADEDOTUN,
MD
ADEYEKUN, OMOBOLANLE
OMOLAYO, MD
P5766
ADEYEMI, OLUYEMISI ADEDOYIN,
MD
P5583
2/6/2009
2/6/2014 PEDIATRICS
1/15/2013
3/1/2013
1/4/2013
P1956
ADEYEMO, FOYEKE ADEYELU, MD
N8477
P4842
ADEYEMO, ISHOLA SIKIRU, MD
ADEYEMO, VIVIAN
OGHENEVWEDE, MD
11/15/2012
OBSTETRICS &
GYNECOLOGICAL
3/15/2018 SURGERY
EMERGENCY
2/1/2017 MEDICINE
OBSTETRICS &
GYNECOLOGICAL
1/18/2016 SURGERY
GERIATRICS 11/15/2017 INTERNAL MEDICINE
N7197
ADGEH, CHERINET SIRAW, MD
8/2/2010
N4881
2/5/2010
N7385
N9668
ADHIKARY, RAVI , MD
ADIMOOLAM,
VENKATAVIJAYBABU, MD
ADJOVU, ADELAIDE ADEDE, MD
P5917
ADKISON, JONATHAN SCOTT, MD
4/1/2013
N9497
ADLER, GRIT ARMSTRONG, MD
5/2/2011
N5522
ADLER, MICHAEL THOMAS, MD
4/9/2010
P2409
ADU-LARTEY, SAMUEL MAXWELL,
DO
2/5/2015 RADIOLOGY
GASTROENTEROLOG
8/16/2015 Y
DIAGNOSTIC
4/1/2018 RADIOLOGY
INTERVENTIONAL
5/2/2016 RADIOLOGY
OBSTETRICS AND
4/9/2015 GYNECOLOGY
ORTHOPEDIC
SURGERY OF THE
3/15/2017 SPINE
P0530
ADYANTHAYA, ROHIT, MD
3/15/2013
2/1/2012
1/18/2011
8/16/2010
5/16/2011
3/15/2012
8/1/2011
Secondary Specialty
(Self-Designated)
FAMILY PRACTICE EMERGENCY MED
PEDIATRIC EMER
MED (EM)
HOSPITALIST
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
SAN ANTONIO TX
Disciplinary
Status Date
12/17/2012 None
N/A
12/17/2012 None
N/A
ACTIVE
LICENSE
ISSUED
3/6/2009 None
N/A
1/15/2013 None
N/A
ACTIVE
3/12/2013 None
N/A
POPLAR
BLUFF
MO
ACTIVE
2/4/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
4/4/2013 None
N/A
2/1/2012 None
N/A
EMERGENCY
MEDICINE
OBSTETRICS AND
GYNECOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
GERIATRICS
BROOKLYN
NEW HYDE
PARK
NY
ACTIVE
2/14/2011 None
N/A
NY
ACTIVE
12/31/2012 None
N/A
NEPHROLOGY
SHREVEPORT LA
ACTIVE
LICENSE
ISSUED
8/23/2010 None
N/A
2/5/2010 None
N/A
ODESSA
HOUSTON
TX
TX
ACTIVE
ACTIVE
8/23/2010 None
5/27/2011 None
N/A
N/A
NEURO-RADIOLOGY
TEMPLE
TX
ACTIVE
4/23/2013 None
N/A
RADIOLOGY
BEEVILLE
TX
ACTIVE
LICENSE
ISSUED
5/9/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
3/20/2012 None
N/A
ACTIVE
8/5/2011 None
N/A
ORTHOPEDIC
SURGERY
OPHTHALMOLOGY VITREOUS SURGERY MCALLEN
Page 4 of 300
TX
License
Number
N8602
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P0330
7/15/2011
P0692
P0945
AFTAB, MUHAMMAD , MD
AFTAB, RAFIA, MD
8/15/2011
9/15/2011
N2358
AGADI, SATISH , MD
N8750
P0890
AGARWAL, ANAGHA PATIL, MD
AGARWAL, ANSHUL , MD
2/15/2011
9/1/2011
9/1/2016 NUCLEAR MEDICINE
P4405
AGARWAL, HEMANT SHYAM, MD
9/17/2012
N9669
N9155
AGARWAL, NIKHIL, MD
AGARWAL, SUNEAL KUMAR, MD
5/16/2011
4/1/2011
P6941
P6760
AGBORO-IDAHOSA, EJIRO VIVIAN,
MD
AGGARWAL, MONIKA, MD
4/3/2009
6/14/2013
6/3/2013
THORACIC
CARDIOVASCULAR
8/15/2016 SURGERY
PEDIATRIC
4/3/2014 NEUROLOGY
6/3/2013
11/6/2009
11/4/2011
6/14/2018 PSYCHIATRY
6/3/2018 NEPHROLOGY
CARDIOVASCULAR
6/3/2018 SURGERY
6/3/2011
11/30/2012
P4922
AGNONE, JOHN HENRY, MD
AGOMO, EMELIKE UCHECHI, MD
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
N8751
AGUSALA, PRATAP, MD
2/15/2011
INTERVENTIONAL
2/15/2016 CARDIOLOGY
P0946
AHLUWALIA, MANEESHA , MD
9/15/2011
INFECTIOUS
9/15/2016 DISEASES
N9798
Practice City
NEONATALNEUROMUSCULAR
2/4/2016 PERINATAL MEDICINE DISEASE
ADZOTOR, KWASI, MD
AFOLABI, FOLASHADE
CATHERINE, MD
P6761
N4236
P1257
2/4/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
LICENSE
ISSUED
2/4/2011 None
N/A
TX
ACTIVE
8/5/2011 None
N/A
GENERAL SURGERY HOUSTON
FAMILY PRACTICE
GARLAND
TX
TX
ACTIVE
ACTIVE
8/22/2011 None
11/11/2011 None
N/A
N/A
PEDIATRICS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/8/2009 None
N/A
2/15/2011 None
9/8/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
10/1/2012 None
N/A
5/16/2011 None
4/6/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
6/25/2013 None
6/7/2013 None
N/A
N/A
6/3/2013 None
12/3/2009 None
11/8/2011 None
N/A
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
2/15/2011 None
N/A
12/14/2011 None
N/A
DALLAS
FAMILY MEDICINE
PEDIATRIC
INTENSIVE CARE
HOUSTON
NASHVILLE
CHILD AND
ADOLESCENT
PSYCHIATRY
SIOUX CITY
INTERNAL MEDICINE
GALVESTON
FAMILY PRACTICE
HOSPITALIST
INTERNAL MEDICINE
Page 5 of 300
TN
IA
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N9994
AHMAD, AFTAB, MD
6/15/2011
N6134
P0947
P0331
AHMAD, HAMEED, MD
AHMAD, SALMAN, MD
AHMAD, TANVIR, MD
6/4/2010
9/15/2011
7/15/2011
P1721
AHMADI, SARA , MD
ENDOCRINOLOGY,
DIABETES AND
1/2/2017 METABOLISM
P1258
AHMADIAN, VERONICA ARCE, MD
1/2/2012
11/4/2011
AHMED, AGHA JAMIL, MD
4/12/2013
P1509
AHMED, ASHRAF, MD
12/1/2011
N8479
AHMED, ATHEER JAAFAR, MD
1/18/2011
EMERGENCY
1/18/2016 MEDICINE
AHMED, FAROOQUE, MD
N0594
AHMED, HALA MOHAMED ALY, MD
4/9/2010
8/29/2008
HOSPITALIST
INTERVENTIONAL
CARDIOLOGY
EMERGENCY
MEDICINE
GALVESTON
TX
ACTIVE
1/4/2012 None
N/A
SAN ANTONIO TX
ACTIVE
11/17/2011 None
N/A
WICHITA
ACTIVE
LICENSE
ISSUED
4/23/2013 None
N/A
12/1/2011 None
N/A
KS
P1841
AHMED, IRFAN, MD
1/17/2012
1/17/2017 NEPHROLOGY
INTERNAL MEDICINE
N7047
N3423
AHMED, MOHAMMAD , MD
AHMED, NAGI HASSAN , MD
7/15/2010
8/21/2009
PEDIATRICS
N4889
N0597
AHMED, SANA MAHMOOD, MD
AHMED, SHAMOON, MD
2/5/2010
8/29/2008
2/5/2015 NEPHROLOGY
P5319
AHMED, SOHAIL, MD
2/1/2013
AHMED, SYED MASHOOD, MD
1/15/2013
P4406
AHMED, SYED NASIM, MD
9/17/2012
P2412
N9156
AHMED, YASIR, MD
AHN, DANIEL , DO
3/15/2012
4/1/2011
INFECTIOUS
3/15/2017 DISEASES
Page 6 of 300
N/A
6/4/2010 None
10/3/2011 None
8/31/2011 None
N/A
N/A
N/A
1/25/2011 None
N/A
EL PASO
TX
ACTIVE
4/16/2010 None
N/A
ACTIVE
11/11/2008 None
N/A
7/22/2009 None
N/A
1/17/2012 None
N/A
7/15/2010 None
9/28/2009 None
N/A
N/A
2/5/2010 None
9/5/2008 None
N/A
N/A
2/1/2013 None
N/A
MCKINNEY
HOUSTON
P5254
6/15/2011 None
ACTIVE
TX
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
CARDIOVASCULAR
IMAGING
Disciplinary
Status Date
TX
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
AHMED, IBRAHIM ABDEL KADER
SAYED, MD
Registration
Status Date
Disciplinary
Status of
Texas
License
AUSTIN
N1518
12/12/2008
LOVELAND
YAKIMA
Practice City
HOSPITALIST
P6120
N5525
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
OH
ACTIVE
WA
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
CARROLL
IA
ACTIVE
2/7/2013 None
N/A
MODESTO
CA
ACTIVE
9/24/2012 None
N/A
ODESSA
TX
ACTIVE
ACTIVE
3/16/2012 None
4/20/2011 None
N/A
N/A
License
Number
Physician Name
P3108
N9996
AIGBIVBALU, LEMUEL OSE, MD
AILNANI, SUPRIYA, MD
N4890
AINA, OLUYEMI, MD
dicaid
dicaid
Agreement
End Date
Designated)
5/15/2012
6/15/2011
2/5/2010
10/29/2010
1/4/2013
N8264
AJALA, MOYOSADE ADEYINKA, MD
12/15/2010
N1247
10/10/2008
P6942
AJELABI, AKINYINKA ABIDEMI, MD
AJIBADE, OLUWASEUN AKINWALE,
MD
PULMONARY
10/10/2013 MEDICINE
P1723
AJIBADE, TOPE, MD
1/2/2012
P6763
6/3/2013
P1511
AJMAL, MUHAMMAD SULEMAN, MD
AJUMOBI, ADEWALE BABATUNDE,
MD
12/1/2011
P6564
N9498
AKALONU, AMAKA , MD
AKANDE, LATIFA O, DO
5/15/2013
5/2/2011
N4891
AKAY, MEHMET HAKAN, MD
N4241
AKHLAGHI, MOHSEN , MD
P6311
P6312
N7899
N3427
AKHTAR, OMAR H, MD
AKHTER, JAWEED, MD
AKIN, ANGELA RENEE, DO
AKIN, LAURA DESPORTE, MD
AKINKUOTU, ADESOLA CYNTHIA
OMOWONUOLA, MD
AKINMERESE, OLAWALE OPEYEMI,
MD
AKINYEMI, EMMANUEL OLUSESAN,
MD
5/1/2013
5/1/2013
10/15/2010
8/21/2009
THORACIC
CARDIOVASCULAR
2/5/2015 SURGERY
EMERGENCY
11/6/2014 MEDICINE
ORTHOPEDIC
5/1/2018 SURGERY
8/15/2013
P7603
N7199
N4242
11/6/2009
8/2/2010
11/6/2009
GALVESTON
AUSTIN
TX
TX
SLEEP MEDICINE
6/14/2018 HOSPITALIST
2/5/2010 None
N/A
10/29/2010 None
1/15/2013 None
N/A
N/A
12/15/2010 None
N/A
10/14/2008 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/1/2013 None
N/A
1/2/2012 None
N/A
6/3/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
2/23/2012 None
N/A
5/15/2013 None
6/1/2011 None
N/A
N/A
LICENSE
ISSUED
2/5/2010 None
N/A
TX
ACTIVE
2/1/2010 None
N/A
AUSTIN
TX
KARACHI
CEDAR PARK TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
INFECTIOUS
11/6/2014 DISEASES
CLEVELAND
NY
TX
INTERNAL MEDICINE
GASTROENTEROLOG
Y
SAN ANTONIO TX
PEDIATRICS
GENERAL SURGERY
EMERGENCY
MEDICINE
HOUSTON
DIABETES
HOSPITALIST
FORT WORTH TX
INTERNAL MEDICINE HARLINGEN
Page 7 of 300
Disciplinary
Status Date
N/A
N/A
BROOKLYN
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
5/25/2012 None
6/20/2011 None
AIRD, PAMELA ELIZABETH, MD
AIZMAN, ALEXANDER, MD
2/5/2010
Practice City
2/5/2015
N7987
P5153
6/14/2013
Secondary Specialty
(Self-Designated)
PEDIATRIC
INFECTIOUS
DISEASE
Registration
Status of
Practice
Texas
State
License
ACTIVE
5/7/2013
7/3/2013
10/20/2010
9/22/2009
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
8/23/2013 None
N/A
ACTIVE
8/20/2010 None
N/A
ACTIVE
11/13/2009 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N7049
AKKANTI, YAMINI APARNA, MD
P2569
AKLE, NASSIM , MD
N3428
N7200
AKMAN, CIGDEM INAN, MD
AKOR, CHARLOTTE MARTHA, MD
8/21/2009
8/2/2010
P7375
P6565
P7376
AKOTIA, VIMESH BALUBHAI, MD
AKSADE, ARTUN, MD
AKTUNC, ERDEM, MD
8/1/2013
5/15/2013
8/1/2013
P5020
AKUNYILI, EDOZIE JOHN, MD
12/17/2012
P5020
12/17/2012
P5020
12/17/2012
P1613
AL KHASAWNEH, EIHAB, MD
12/15/2011
P0160
N7669
ALALAWI, RAED , MD
ALAM, AKHTAR, MD
7/1/2011
9/15/2010
P0332
P6314
P5768
ALAM, MD MONJURUL, MD
ALAM, NIMAT , MD
ALATTAR, MONA LISA , MD
7/15/2011
5/1/2013
3/15/2013
P0333
ALAUDDIN, KASHIF, MD
7/15/2011
P6122
4/12/2013
P2570
ALAVA, IBRAHIM III, MD
ALAWI-KAKOMANOLIS, NADIA
ANNE, MD
N9158
ALBERTA-WSZOLEK, LAUREN, MD
P5769
ALBERTS, MARK J, MD
N5527
ALBO, ZIMBUL , MD
7/15/2010
4/2/2012
Secondary Specialty
(Self-Designated)
Practice City
4/2/2017 RADIOLOGY
CLINICAL
8/21/2014 CHILD NEUROLOGY
NEUROPHYSIOLOGY HOUSTON
HOUSTON
GASTROENTEROLOG
8/1/2018 Y
INTERNAL MEDICINE PALESTINE
5/15/2018 GENERAL SURGERY
ODESSA
EMERGENCY
12/17/2017 MEDICINE
WOODLANDS
EMERGENCY
12/17/2017 MEDICINE
WOODLANDS
EMERGENCY
12/17/2017 MEDICINE
WOODLANDS
PEDIATRIC
NEPHROLOGY
PULMONARY
CRITICAL CARE
7/1/2016 INTERNAL MEDICINE MEDICINE
LUBBOCK
PSYCHIATRY
HOUSTON
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
GERIATRICS
ODESSA
3/15/2018 INTERNAL MEDICINE ONCOLOGY
DALLAS
4/1/2011
4/1/2016 DERMATOLOGY
3/15/2013
3/15/2018 NEUROLOGY
4/9/2010
4/9/2015 NEUROLOGY
VASCULAR
NEUROLOGY
Page 8 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/15/2010 None
N/A
4/2/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
9/1/2009 None
8/10/2010 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
8/26/2013 None
5/17/2013 None
8/6/2013 None
N/A
N/A
N/A
TX
ACTIVE
1/7/2013 None
N/A
TX
ACTIVE
1/7/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
1/7/2013 None
N/A
12/15/2011 None
N/A
ACTIVE
ACTIVE
7/6/2011 None
9/23/2010 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/25/2011 None
5/9/2013 None
4/1/2013 None
N/A
N/A
N/A
7/15/2011 None
N/A
TX
ACTIVE
4/16/2013 None
N/A
BROOKLYN
NY
ACTIVE
4/5/2012 None
N/A
BELLAIRE
TX
ACTIVE
4/7/2011 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
3/21/2013 None
N/A
4/9/2010 None
N/A
INTERNAL MEDICINE
OTORHINOLARYNGOL
4/12/2018 OGY
OTOLARYNGOLOGY HOUSTON
4/2/2012
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
TX
TX
TX
License
Number
Physician Name
N9428
ALBRECHT, WILLIAM CLAY, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/15/2011
P0694
ALBRITTON, KAREN HALABURT,
MD
ALBUQUERQUE, KEVIN VINCENT
DE PAUL, MD
8/15/2011
P7377
P1512
P3603
ALBURKI, ABDUSSALAM M, MD
AL-CHADERCHI, SILVANA Y, MD
ALDEIRI, MOLHAM , MD
8/1/2013
12/1/2011
6/15/2012
P2088
ALDRICH, JOSEPH ALBERT III, DO
2/10/2012
N3432
ALEJANDRO, KARLA C, MD
8/21/2009
P6315
P5321
P0948
P3277
ALEMU, BENYAM GIZACHEW, MD
ALETI, SUMITH CHANDER REDDY,
MD
ALEXANDER, AMITA, MD
ALEXANDER, IAN J, MD
P5504
P5922
N4895
2/5/2010
5/1/2013
2/5/2015 ONCOLOGY
RADIATION
8/15/2016 ONCOLOGY
EMERGENCY
2/10/2017 MEDICINE
OPHTHALMOLOGY 8/21/2014 VITREOUS SURGERY
2/1/2013
9/15/2011
6/1/2012
2/1/2018 CARDIOLOGY
6/1/2017 OTOLARYNGOLOGY
ALEXANDER, NEBU T, MD
2/8/2013
4/1/2013
4/1/2018 ONCOLOGY
P1724
ALEXANDER, WARREN, MD
ALFARAWATI, MOHAMMAD
NABEEL, MD
1/2/2012
P4538
P2184
P7238
ALFONSO, JOHN DENNIS
CAYANAN, MD
ALFORD, ERIC NATHAN, MD
ALFORD, RAPHAEL ETARIO, MD
P6764
AL-HAFEZ, BARAA , MD
N9157
N1524
AL-HAFNAWI, MOTAZ KHALED, MD
ALHAZIM, DINA, MD
N6126
AL-HINDI, AHMAD, MD
6/4/2010
N7201
AL-HOUSSEINI, ALI , MD
8/2/2010
10/1/2012
3/1/2012
7/15/2013
6/3/2013
4/1/2011
12/12/2008
PHYSICAL MED. &
10/1/2017 REHABILITATION
7/15/2018 RADIOLOGY
NEUROLOGICAL
6/3/2018 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
BRACHYTHERAPY/HY
PERTHERMIA
DALLAS
INFECTIOUS
DISEASES
HOUSTON
PEDIATRICS
OPHTHALMOLOGY
FORT
BENNING
CORPUS
CHRISTI
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
INFECTIOUS
DISEASES
DESOTO
HEMATOLOGY/ONCO
LOGY
EL PASO
PULMONARY
DISEASES
UNDERSEA AND
HYPERBARIC MED
(PREV MED)
SAN ANTONIO
WACO
DALLAS
HEPATOLOGY
6/4/2015 INTERNAL MEDICINE CARDIOLOGY
OBSTETRICS &
GYNECOLOGICAL
8/2/2015 SURGERY
Page 9 of 300
MIAMI
DALLAS
CORSICANA
2/5/2010 None
N/A
TX
ACTIVE
8/25/2011 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
8/6/2013 None
12/6/2011 None
6/18/2012 None
N/A
N/A
N/A
GA
ACTIVE
2/20/2012 None
N/A
TX
8/31/2009 None
N/A
5/1/2013 None
N/A
TX
NM
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
2/1/2013 None
9/23/2011 None
6/13/2012 None
N/A
N/A
N/A
TX
ACTIVE
2/12/2013 None
N/A
TX
ACTIVE
4/4/2013 None
N/A
ACTIVE
1/9/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
10/8/2012 None
3/13/2012 None
7/17/2013 None
N/A
N/A
N/A
ACTIVE
6/10/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/12/2011 None
1/5/2009 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
8/18/2010 None
N/A
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
LEVELLAND
LOS ALAMOS
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
4/22/2011 None
N/A
TX
TX
TX
FL
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P0532
P5322
ALI, ABDULFATAH MOHAMED, MD
ALI, ADIL RUKNUDDIN, MD
8/1/2011
2/1/2013
N6137
P0334
ALI, BAKHTIAR , MD
ALI, FOZIA AKHTAR, MD
6/4/2010
7/15/2011
P4843
ALI, ISHAQ, MD
P7379
P7735
ALI, RIYAZ MOHAMMED, MD
ALI, SARFRAZ, MD
P4923
ALI, SAYED KARAR, MD
P6568
ALI, SHAHID, MD
5/15/2013
GASTROENTEROLOG
5/15/2018 Y
P2822
ALI, SYED MUJTABA, MD
4/13/2012
N9338
ALI, SYED OMAR, MD
4/8/2011
N6138
ALI, SYED SAMEER, MD
6/4/2010
P3111
P7736
P2413
ALI, WAIL, MD
ALIBHAI, MUSTAFA
HUSSAMUDDIN, MD
ALICK, SASHA , MD
P3500
P3501
ALI-OSMAN, FRANCIS REGINALD,
MD
ALIOTTA, MICHELLE LYNN, MD
N7388
ALJAWADI, GEORGIA , DO
8/16/2010
P0949
ALKALAY, AVISHAI ALBERT, MD
9/15/2011
P0950
ALKALAY, MICHELE JACQUELINE,
MD
9/15/2011
N4243
P1515
AL-KHOURY, GEORGES ELIE, MD
ALLAIRE, BO JONATHAN, MD
11/6/2009
12/1/2011
11/15/2012
8/1/2013
8/30/2013
11/30/2012
11/15/2017 NEUROLOGY
8/30/2018 PATHOLOGY
Secondary Specialty
(Self-Designated)
OPHTHALMOLOGY CORNEA
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
NEURO-PHYSIOLOGY
(NEUROLOGY)
CYTOPATHOLOGY
PALLIATIVE
MEDICINE
NEPHROLOGY
DERMATOLOGIC
SURGERY
N/A
N/A
6/4/2010 None
7/28/2011 None
N/A
N/A
12/31/2012 None
N/A
8/12/2013 None
9/9/2013 None
N/A
N/A
11/30/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/29/2013 None
N/A
4/13/2012 None
N/A
4/15/2011 None
N/A
6/4/2010 None
N/A
5/15/2012 None
N/A
8/30/2013 None
3/20/2012 None
SEE
PREVIOUS
6/8/2012 ORDER
6/15/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/15/2012
EMERGENCY
6/4/2015 MEDICINE
PEDIATRIC INTENSIVE
5/15/2017 CARE
PEDIATRICS
8/30/2013
3/15/2012
3/15/2017 NEUROLOGY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/8/2012
6/8/2012
OBSTETRICS AND
MATERNAL AND
FETAL MEDICINE
PEDIATRIC
GASTROENTEROLOG
9/15/2016 Y
Disciplinary
Status Date
8/1/2011 None
2/6/2013 None
ACTIVE
LEONARDTOW
N
MD
CRANFORD
NJ
Registration
Status Date
Disciplinary
Status of
Texas
License
HARLINGEN
CORPUS
CHRISTI
TX
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
9/8/2010 None
N/A
BRONX
NY
ACTIVE
9/20/2011 None
N/A
MOUNT KISCO NY
ACTIVE
9/26/2011 None
N/A
ACTIVE
ACTIVE
1/22/2010 None
12/5/2011 None
N/A
N/A
11/6/2014 VASCULAR SURGERY GENERAL SURGERY PITTSBURGH
BAYTOWN
Page 10 of 300
PA
TX
6/11/2012
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PHYSICAL MED. &
4/2/2012
1/17/2012
2/6/2009
10/10/2008
EMERGENCY
7/15/2010
7/15/2015 MEDICINE
P2571
P1844
L3554
N1248
ALLAM, ANAND M, MD
ALLANKU, SARAT, MD
ALLEMAN, DAVID GEORGE, MD
ALLEN, BARBARA LYNNE, MD
N7050
ALLEN, JOSHUA DEWAYNE, DO
N9159
N8880
ALLEN, KYLE PIERCE, MD
ALLEN, LISA RACHEL, MD
4/1/2011
3/1/2011
N7204
ALLEN-RHOADES, WENDY , MD
8/2/2010
8/2/2015 PEDIATRICS
P7380
ALLISON, JERRY ALVIN, MD
8/1/2013
N6140
ALLISON, NATHAN D, MD
ALMEIDA-JONES, MYRIAM
EVELINE, MD
6/4/2010
PEDIATRICS,
P6125
N8365
4/12/2013
5/29/2009
P6320
ALMOHAMMED, SALAH NASER, MD
ALOBA, MARIA CHONA BRIONES ,
MD
ALOBAIDI, AHMED MOHAMMED
KHAIRI, MD
N3437
ALONSO, WILFRED JEROME, MD
8/21/2009
P6767
ALOOR, SIMMY , MD
N2913
1/3/2011
5/1/2013
6/3/2013
N6141
ALOZIE, OGECHIKA KARL, MD
6/4/2010
N6806
ALQAHTANI, SALEH ALI, MD
AL-RAJABI, RAED MOH'D TAISEER ,
MD
7/1/2010
N3430
P7240
N9672
ALSAAB, SAAD , MD
AL-SAADI, MUKHTAR A, MD
P0534
ALSHAREEF, BASHAR NIMAN, MD
8/21/2009
7/15/2013
5/16/2011
8/1/2011
Secondary Specialty
(Self-Designated)
Practice City
SPINAL CORD
INJURY MEDICINE
HOUSTON
INTERNAL MEDICINE
HOUSTON
TYLER
EMERGENCY
MEDICINE
OTOLOGY/NEUTOTO
LOGY
DALLAS
HOUSTON
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HOUSTON
EMERGENCY
MEDICINE
DALLAS
NEW YORK
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
5/29/2014 ONCOLOGY
8/21/2014 SLEEP MEDICINE
FAMILY MEDICINE
INTERVENTIONAL
CARDIOLOGY
OTHER SPECIALTY
Page 11 of 300
N/A
N/A
N/A
N/A
7/15/2010 None
N/A
4/5/2011 None
3/21/2011 None
N/A
N/A
TX
ACTIVE
8/24/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/6/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/25/2013 None
N/A
1/3/2011 None
N/A
NY
TX
ACTIVE
6/3/2009 None
N/A
DALLAS
TX
CALGARY,
ALBERTA TZY
4RZ
ACTIVE
5/7/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/9/2009 None
N/A
6/3/2013 None
N/A
6/4/2010 None
N/A
INFECTIOUS
DISEASES
None
None
None
None
ACTIVE
ACTIVE
6/3/2018 PEDIATRICS
GASTROENTEROLOG
7/1/2015 Y
HEPATOLOGY
4/4/2012
1/23/2012
2/20/2009
10/15/2008
Disciplinary
Status Date
TX
TX
1/3/2016 PEDIATRICS
HEMATOLOGY INTERNAL MEDICINE EL PASO
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
ACTIVE
7/15/2010 None
N/A
SAN ANTONIO TX
ACTIVE
9/9/2009 None
N/A
TOMBALL
HOUSTON
ACTIVE
ACTIVE
LICENSE
ISSUED
7/23/2013 None
5/20/2011 None
N/A
N/A
8/1/2011 None
N/A
TX
TX
License
Number
N1250
Physician Name
P7058
ALSHEIKH, ODAY, MD
ALSOBROOKS, CURRISSA PRUITT,
MD
J6300
dicaid
dicaid
Agreement
End Date
Designated)
OPHTHALMOLOGY 10/10/2008
10/10/2013 CORNEA
7/1/2013
ALSOP, ERNEST CARSON, MD
5/16/2011
N7672
P0535
ALTAMIRANO, LEO CARDENAS, MD
ALTAMIRANO, RAY , MD
9/15/2010
8/1/2011
N9998
ALTMEYER, MARY DENNIS, MD
6/15/2011
P7059
ALVA, MARIA DOLORES, MD
P7738
ALVARADO, SERGIO ANTONIO, MD
P1041
N2916
N3439
ALVAREZ-CARDONA, JULIO JOSE,
MD
ALVES, PATRICE , MD
ALVES, TAHIRA PALMER , MD
10/3/2011
5/29/2009
8/21/2009
N7900
ALVI, NAVEED IKRAM, MD
P2186
ALVI, SAADIA , MD
3/1/2012
N4902
ALY, SALMAN SIRAJ, MD
2/5/2010
P2943
P6569
AMAN, ZARMINA, MD
AMARIA, RODABE NAVROZE, MD
FAMILY PRACTICE
SPORTS MEDICINE PHYSICAL MEDICINE
& REHABILITATION
SAN ANTONIO TX
SAN ANTONIO TX
4/3/2009
8/21/2009
AMACHER, AARON GEORGE III, MD
AMADOR, MELISSA , MD
TX
7/1/2018 PEDIATRICS
ALVAREZ, AIXA LYMARIE , MD
ALVAREZ, ALLEN ALBERT, MD
P6321
N8267
GALVESTON
8/30/2013
7/1/2013
N2374
N3438
ALY, SARFRAZ, MD
Practice City
SAN ANTONIO TX
DERMATOPATHOLO
GY
PEDIATRIC CRITICAL
CARE MEDICINE
PENSACOLA FL
SPORTS MEDICINE
(FAMILY PRACTICE) EL PASO
TX
PHYSICAL MED. &
N4903
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
10/15/2010
2/5/2010
5/1/2013
12/15/2010
5/1/2012
5/15/2013
10/15/2015 RADIOLOGY
ENDOCRINOLOGY,
DIABETES AND
3/1/2017 METABOLISM
INTERNAL MEDICINE
NEPHROLOGY
SAN ANTONIO TX
SAN ANTONIO TX
RADIOLOGY
INTERNAL MEDICINE GALVESTON
TX
INFECTIOUS
DISEASES
OBSTETRICS AND
5/1/2017 GYNECOLOGY
5/15/2018 ONCOLOGY
Page 12 of 300
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/5/2008 None
N/A
7/1/2013 None
UNDER
BOARD
5/27/2011 ORDER
N/A
9/15/2010 None
8/5/2011 None
N/A
N/A
6/15/2011 None
N/A
ACTIVE
7/31/2013 None
N/A
ACTIVE
9/9/2013 None
N/A
ACTIVE
ACTIVE
5/11/2009 None
8/28/2009 None
UNDER
BOARD
10/21/2011 ORDER
6/30/2009 None
9/25/2009 None
N/A
N/A
10/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/30/2012 None
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
5/3/2011
9/13/2011
N/A
N/A
ARLINGTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
5/7/2013 None
1/14/2011 None
N/A
N/A
PLANO
HOUSTON
TX
TX
ACTIVE
ACTIVE
5/4/2012 None
7/9/2013 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
FP/OSTEO
MANIPULATION
5/1/2013
5/1/2018 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
LICENSE
ISSUED
5/1/2013 None
N/A
P6322
AMARO, JUSTIN AARON, DO
K9479
AMATO, MALENA MARIE, MD
12/17/2012
OPHTHALMOLOGY RECONST SURGERY AUSTIN
TX
ACTIVE
1/1/2013 None
N/A
K9479
12/17/2012
TX
ACTIVE
1/1/2013 None
N/A
K9479
AMAYA CHINCHILLA, HECTOR
GERARDO, MD
AMAYA HELLMAN, DIANA STELLA,
MD
12/17/2012
TX
ACTIVE
1/1/2013 None
N/A
HARLINGEN
TX
ACTIVE
9/5/2008 None
N/A
HOUSTON
TX
ACTIVE
11/19/2009 None
N/A
PHILADELPHIA PA
ACTIVE
6/19/2013 None
N/A
ACTIVE
LICENSE
ISSUED
12/21/2010 None
N/A
2/5/2010 None
N/A
7/9/2013 None
N/A
4/8/2011 None
N/A
N0605
N4246
8/29/2008
11/6/2009
6/3/2013
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
P6770
AMBARDEKAR, ADITEE PARAG, MD
H6762
AMBERGER, DAVID MARCUS, MD
N4905
AMBREEN, FARHANA, MD
P6944
AMBRUZS, JOSEPHINE MARIE, MD
6/14/2013
N9339
4/8/2011
P2944
N6807
P5584
AMBY, ALEXANDER SCOTT, MD
AMECHI-OBIGWE, ADANNA JULIET,
MD
AMER, ISRA MOHAMMAD, MD
AMIN, NIRAV, DO
ACTIVE
LICENSE
ISSUED
5/1/2012
7/1/2010
3/1/2013
ACTIVE
ACTIVE
ACTIVE
5/10/2012 None
7/14/2010 None
4/3/2013 None
N/A
N/A
N/A
P3605
AMIN, TANIA , MD
6/15/2012
N7389
N7673
AMIRAFSHARI, AKBAR, MD
AMIRLAK, BARDIA, MD
8/16/2010
9/15/2010
9/15/2015 PLASTIC SURGERY
L3228
AMJAD, RAMAK RAYMOND, MD
12/15/2010
2/5/2010
2/5/2010
12/15/2015 PATHOLOGY
DERMOPATHOLOGY HONOLULU
ANATOMIC/CLINICAL
6/14/2018 PATHOLOGY
HI
FAMILY PRACTICE
LITTLE ROCK
HOSPITALIST
GERIATRIC
PSYCHIATRY
THORACIC
CARDIOVASCULAR
SURGERY
HAND SURGERY
NEONATAL2/5/2015 PERINATAL MEDICINE
Page 13 of 300
AR
DALLAS
TX
ACTIVE
6/19/2012 None
N/A
HOUSTON
DALLAS
TX
TX
8/20/2010 None
10/4/2010 None
N/A
N/A
PLANO
TX
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
2/5/2010 None
N/A
License
Number
Physician Name
N3443
AMMAR, NEAL , MD
P3502
AMMAR, RICHARD FREDERICK JR,
MD
N2919
AMMAR, SHERIF , MD
TM00457 AMOLI, SEAN REZA, MD
P2574
N7208
AMOR, COURTNEY JOSEPH, MD
ANAMEKWE, KENECHIM
ANYANWU, MD
dicaid
dicaid
Agreement
End Date
Designated)
DERMATOLOGIC
8/21/2009
8/21/2014 SURGERY
6/8/2012
5/29/2009
8/1/2011
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
INTERVENTIONAL
6/8/2017 CARDIOLOGY
DERMATOLOGIC
5/29/2014 SURGERY
OTOLARYNGOLOGY
HAND SURGERY ORTHOPEDIC
SURGERY
ORTHOPEDIC
4/2/2017 SURGERY
8/2/2010
ANAND, AASHISH , MD
2/15/2011
N3445
ANAYA, CANDIDO JAVIER, MD
8/21/2009
N3446
ANAYA, CARLOS , MD
8/21/2009
P6127
ANAYA, SAMUEL JR, MD
4/12/2013
N8604
ANCAYA, DORA VICTORIA, MD
P7739
ANDACHEH, IDEN DAVID, MD
N9500
ANDERS, DANDREA MICHELLE, MD
N4248
N3447
N4249
ANDERSON, APRIL LAUREN, MD
ANDERSON, C ERIK, MD
ANDERSON, CHRISTINE
MARCELITA, MD
N2378
ANDERSON, CHRISTOPHER TODD,
MD
N0606
ANDERSON, CODY NEAL, MD
5/2/2011
11/6/2009
8/21/2009
11/6/2009
4/3/2009
8/29/2008
IOWA CITY
SANTA
MONICA
NEONATALPERINATAL
MEDICINE
EMERGENCY
MEDICINE
Disciplinary
Status Date
ACTIVE
10/22/2009 None
N/A
IA
ACTIVE
6/12/2012 None
N/A
CA
ACTIVE
LICENSE
ISSUED
8/27/2009 None
N/A
8/1/2011 None
N/A
HOUSTON
TX
ACTIVE
4/13/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
9/27/2010 None
N/A
2/15/2011 None
N/A
11/19/2009 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
8/31/2009 None
N/A
4/12/2013 None
N/A
2/4/2011 None
N/A
8/30/2013 None
N/A
6/13/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
11/6/2009 None
9/10/2009 None
N/A
N/A
TX
ACTIVE
11/11/2009 None
N/A
OH
ACTIVE
4/13/2009 None
N/A
TX
ACTIVE
9/11/2008 None
N/A
CORPUS
CHRISTI
TX
8/30/2018 VASCULAR SURGERY GENERAL SURGERY
PHYSICAL MED. &
HOUSTON
EMERGENCY
11/6/2014 MEDICINE
KYLE
ANESTHESIOLOGY 11/6/2014 ANESTHESIOLOGY
PAIN MANAGEMENT AUSTIN
WRIGHT
PATTERSON
4/3/2014 PSYCHIATRY
AFB
ORTHOPEDIC
ORTHOPEDIC
8/29/2013 TRAUMA
SURGERY
HOUSTON
Page 14 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
CA
PEDIATRIC
OPHTHALMOLOGY
N8756
8/30/2013
Practice City
SANTA
MONICA
8/1/2016 RADIOLOGY
4/2/2012
2/4/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
License
Number
P1157
Physician Name
ANDERSON, GINA KATHLEEN, DO
dicaid
dicaid
Agreement
End Date
Designated)
10/17/2011
N2379
N5533
ANDERSON, GLENN BRIAN, MD
ANDERSON, JAHI KASHKA, MD
4/3/2009
4/9/2010
N9341
ANDERSON, JARED DEAN, MD
4/8/2011
P1159
L9071
ANDERSON, MELANIE RENEE, MD
ANDERSON, ROBERT WESLEY III,
MD
N5534
P2188
10/17/2011
NEUROLOGICAL
4/3/2014 SURGERY
4/9/2015 PSYCHIATRY
ANDREWS, GENEVIEVE ANN, MD
4/9/2010
3/1/2012
N1530
ANDREWS, NICHOLE RENEE, MD
ANEKWE, EMMANUEL
CHUKWUEMEKA, MD
EMERGENCY
3/1/2017 MEDICINE
N4911
ANGEL, RICHARD, DO
N8164
ANGELO, JOSEPH ROBERT II, MD
12/1/2010
N4250
ANGIER, GREGGORY NABIL, MD
11/6/2009
N8605
ANGTUACO, SYLVIA S O, MD
P1444
ANIAKUDO, MAUREEN , MD
11/15/2011
P5024
ANITUBE, MAXIMUS
NWAKALUNNA, MD
12/17/2012
P5024
ANITUBE, MAXIMUS
NWAKALUNNA, MD
12/17/2012
12/17/2012
P0696
ANITUBE, MAXIMUS
NWAKALUNNA, MD
ANNAPUREDDY, CHANDRA
SEKHAR REDDY, MD
P6572
ANNAPURNA, VEERAYYAGARI, MD
P5024
2/5/2010
2/4/2011
8/15/2011
5/15/2013
NEUROLOGICAL
SURGERY
EMERGENCY
10/17/2016 MEDICINE
2/8/2013
12/12/2008
Secondary Specialty
(Self-Designated)
PEDIATRIC
PEDIATRICS,
2/4/2016 CARDIOLOGY
ACTIVE
11/7/2011 None
N/A
GALVESTON
CAMDEN
TX
NJ
ACTIVE
ACTIVE
N/A
N/A
TEMPLE
TX
ACTIVE
4/9/2009 None
4/14/2010 None
SEE
PREVIOUS
4/14/2011 ORDER
DALLAS
TX
ACTIVE
11/1/2011 None
N/A
TX
ACTIVE
2/21/2013 None
N/A
HOUSTON
TX
ACTIVE
4/19/2010 None
N/A
EL PASO
TX
ACTIVE
3/20/2012 None
N/A
12/29/2008 None
N/A
2/5/2010 None
N/A
12/7/2010 None
N/A
11/16/2009 None
N/A
2/4/2011 None
N/A
11/15/2011 None
N/A
12/17/2012 None
N/A
PEDIATRICS
HOUSTON
SURGICAL CRITICAL MOUNT
CARE
PLEASANT
OBSTETRICS AND
Page 15 of 300
Disciplinary
Status Date
TX
SAN ANTONIO TX
FAMILY MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
Registration
Status Date
Disciplinary
Status of
Texas
License
Practice City
COLLEGE
STATION
INTERNAL MEDICINE DENTON
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/11/2011
DALLAS
TX
ACTIVE
1/15/2013 None
N/A
DALLAS
TX
ACTIVE
1/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
8/25/2011 None
N/A
5/15/2013 None
N/A
SAN ANTONIO TX
License
Number
Physician Name
P7242
ANOSIKE, BRENDA IJ, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
7/15/2013
PEDIATRIC
6/15/2012
6/15/2017 PULMONOLOGY
SLEEP MEDICINE
6/3/2011
6/3/2016 PEDIATRICS
NEONATOLOGY
11/6/2009
11/6/2014 NEUROLOGY
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
MD
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/22/2013 None
N/A
P3606
N9801
N4252
ANSARI, ASAD, MD
ANSARI, MOHSIN, MD
ANSARI, SAFDAR ABBAS, MD
P3278
ANSARI, SHAN NUR, MD
6/1/2012
ACTIVE
N6808
ANSLEY, SHARHONDA MARIE, MD
7/1/2010
ACTIVE
7/13/2010 None
N/A
N4253
ANTHONY, KERRI, MD
ACTIVE
12/7/2009 None
N/A
N5535
ANTOINE, CHRISTINA, MD
4/9/2010
7/1/2015 PEDIATRICS
OBSTETRICS AND
FAMILY
PRACTICE/PSYCHIATR
4/9/2015 Y
4/9/2010 None
N/A
P3279
ANTOINE, JILL A, MD
6/1/2012
6/1/2012 None
N/A
P3280
ANTONELLI, MICHAEL JAMES, DO
6/1/2012
P5926
ANTUNES, MARCELO BARROS, MD
4/1/2013
P6574
5/15/2013
P3281
ANUGWOM, CHINASA PAUL, MD
ANUKAM, UZOESHI IHEANACHO,
MD
N1531
N9342
ANUNOBI, ENDALINE AMAKA, MD
ANWAR, MOHSEN, DO
12/12/2008
4/8/2011
P5770
ANWAR, MUHAMMAD SALEEM, MD
P0538
ANWAR, SANOBER SAJJAD, MD
8/1/2011
P4412
9/17/2012
P2577
ANWAR, ZESHAN, MD
ANYAEGBU, ELIZABETH IJEOMA,
MD
4/2/2012
P0001
ANYANWU, CLEMENT, MD
6/15/2011
4/2/2017 PEDIATRICS
EMERGENCY
6/15/2016 MEDICINE
11/6/2009
6/1/2012
3/15/2013
SALISBURY
MCALESTER
OK
ABILENE
TX
OTORHINOLARYNGOL FACIAL PLASTIC
4/1/2018 OGY
SURGERY
URGENT CARE 5/15/2018 FAMILY MEDICINE
FAMILY PRACTICE
8/1/2016 ALLERGY
HOSPITALIST
VASCULAR
SURGERY
PEDIATRIC
NEPHROLOGY
FAMILY MEDICINE
Page 16 of 300
N/A
N/A
N/A
5/10/2012
SAINT
PETERSBURG FL
ACTIVE
6/5/2012 None
N/A
ROCHESTER
NY
ACTIVE
4/3/2013 None
N/A
ELK RIVER
MN
ACTIVE
5/20/2013 None
N/A
TN
ACTIVE
6/27/2012 None
N/A
SAN ANTONIO TX
AURORA
IL
ACTIVE
ACTIVE
12/29/2008 None
4/15/2011 None
N/A
N/A
DALLAS
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
4/26/2013 None
N/A
8/1/2011 None
N/A
12/16/2012 None
N/A
INTERNAL MEDICINE DYERSBURG
4/8/2016 RADIOLOGY
LICENSE
ISSUED
LICENSE
ISSUED
6/15/2012 None
6/10/2011 None
12/30/2009 None
UNDER
BOARD
6/13/2012 ORDER
ST LOUIS
MOUNT
PLEASANT
TX
MO
ACTIVE
4/9/2012 None
N/A
TX
ACTIVE
6/20/2011 None
N/A
License
Number
Physician Name
N9802
ANZ, ALAN, MD
P1617
APONTE, EMMALIND, MD
H9755
APPEL, JEFFREY PAUL, MD
P2947
N9164
AQUINO, KAREN MARGHANITA, MD
AQUINO-WHITE, AIMEE, DO
P1160
ARABZADEH, PAYMAN, MD
TM00458 ARAIZA, BEATRIX , MD
L0751
ARANA, JULIA GARRETT, MD
P5325
ARAPOS, LEONIDAS, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
ORTHOPEDIC
6/3/2011
6/3/2016 SURGERY
HEMATOLOGY/ONCOL HEMATOLOGY/ONCO CORPUS
12/15/2011
12/15/2016 OGY
LOGY
CHRISTI
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
DALLAS
5/1/2012
4/1/2011
5/1/2017 NEUROLOGY
10/17/2011
8/1/2011
5/2/2011
2/1/2013
P1161
ARAS, OMER, MD
10/17/2011
P1618
ARASHVAND, MOJGAN, DO
12/15/2011
N1532
ARAZI, TEOFILO JUAN CARLOS,
MD
12/12/2008
P6326
ARBOLEDA, ANDRES, MD
P0002
ARCHER, JOHANNA SUZANNE
MUIR, MD
P6327
N7390
P6129
P7061
ARENIVAR, LEROY , MD
ARES-VALDES, NIXCELA, MD
AREVALO SOSA, RICARDO
ANTONIO, MD
ARGISHTI, NARINE, MD
P0539
P6773
ARGOTI, PEDRO SALVADOR, MD
ARIAS, GABRIELA AGUAYO, MD
P1517
ARIAS, ROBERT RANET, MD
5/1/2013
6/15/2011
8/1/2016 RADIOLOGY
5/2/2016 PEDIATRICS
DIAGNOSTIC
CARDIOVASCULAR
12/15/2016 DISEASES
EMERGENCY
5/1/2018 MEDICINE
REPRODUCTIVE
ENDOCRINOLOGY
6/15/2016 AND INFERTILITY
5/1/2013
8/16/2010
5/1/2018 PSYCHIATRY
4/12/2013
7/1/2013
8/1/2011
6/3/2013
12/1/2011
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 17 of 300
Disciplinary
Status Date
6/3/2011 None
N/A
ACTIVE
1/6/2012 None
N/A
TX
ACTIVE
8/28/2009 None
N/A
AUSTIN
TX
ACTIVE
ACTIVE
5/7/2012 None
4/11/2011 None
N/A
N/A
LAKE
JACKSON
TX
10/20/2011 None
N/A
COLUMBIA
SC
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
8/1/2011 None
6/20/2011 None
2/15/2013 None
N/A
N/A
N/A
10/17/2011 None
N/A
12/15/2011 None
N/A
3/12/2009 None
N/A
5/8/2013 None
N/A
6/15/2011 None
N/A
6/3/2013 None
9/6/2010 None
N/A
N/A
4/12/2013 None
N/A
NASSAU BAY
OBSTETRICS AND
GYNECOLOGY
CHILD AND
ADOLESCENT
PSYCHIATRY
FAMILY PRACTICE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
HOSPITALIST
OBSTETRICS AND
8/1/2016 GYNECOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
AUSTIN
BELLAIRE
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
SULPHUR
SPRINGS
TX
ACTIVE
8/6/2013 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
8/9/2011 None
6/12/2013 None
N/A
N/A
PORT
ARTHUR
TX
ACTIVE
12/2/2011 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
P5773
Physician Name
ARIENMUGHARE, MARYANNE
ONORIODE, MD
P2578
ARIF, FARHAN AHMAD, MD
N3454
ARISTIZABAL-ORTIZ, ANDRES , MD
8/21/2009
N9501
ARIZA HEREDIA, ELLA JAZMIN, MD
5/2/2011
P6575
ARMAGHANY, TANNAZ, MD
5/15/2013
N8482
ARMIJO, BRYAN S, MD
1/18/2011
N4917
ARMSTRONG, FELICIA ANN, MD
N1533
P6774
ARNOLD, JENNIFER LYNN, MD
ARORA, ALLURY, MD
N8607
ARORA, SUTHEP, MD
ARREAZA GRATEROL, MARIA
MARGARITA, MD
N3458
3/15/2013
4/2/2012
2/5/2010
12/12/2008
6/3/2013
2/4/2011
8/21/2009
Secondary Specialty
(Self-Designated)
Practice City
OBSTETRICS
EL PASO
INFECTIOUS
5/2/2016 DISEASES
HEMATOLOGY/ONCOL
5/15/2018 OGY
INTERNAL MEDICINE HOUSTON
PLASTIC &
RECONSTRUCTIVE
1/18/2016 SURGERY
DALLAS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
PREVENTIVE
MEDICINE
Disciplinary
Status Date
3/15/2013 None
N/A
4/2/2012 None
N/A
9/1/2009 None
N/A
5/2/2011 None
N/A
TX
ACTIVE
7/15/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
1/24/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
1/26/2009 None
6/12/2013 None
N/A
N/A
2/4/2011 None
N/A
HOUSTON
6/3/2018 PEDIATRICS
DALLAS
INFECTIOUS
2/4/2016 DISEASES
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
BEEVILLE
TX
ACTIVE
9/7/2009 None
N/A
EL PASO
TX
ACTIVE
9/12/2008 None
N/A
N0613
ARROYAVE, ANA MARIA, MD
8/29/2008
P4542
P6775
ARROYO-AVILA, MARIANGELI , MD
ARSLANOV, RENAT, MD
10/1/2012
6/3/2013
6/3/2018 PEDIATRICS
DALLAS
NEW YORK
TX
NY
ACTIVE
ACTIVE
10/4/2012 None
6/24/2013 None
N/A
N/A
N1983
ARTIME, CARLOS ALEJANDRO, MD
2/6/2009
HOUSTON
TX
ACTIVE
2/17/2009 None
N/A
AL
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/28/2013 None
N/A
4/12/2013 None
11/11/2009 None
N/A
N/A
8/27/2010 None
N/A
P5154
1/4/2013
PUBLIC
HEALTH/PREVENTIVE
MEDICINE
(GENERAL)
HUNTSVILLE
P6130
N4262
ARUN, MATHAGONDAPALLY S, MD
ARVAPALLI, BHAGYALAKSHMI V,
MD
ARYA, BASANT, MD
4/12/2013
11/6/2009
N7521
ARZILLO, TRACI SHARIN, MD
8/27/2010
CARDIOLOGY
PEDIATRIC ANES
(PEDS)
Page 18 of 300
HOUSTON
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
THORACIC
CARDIOVASCULAR
8/30/2013
8/30/2018 SURGERY
CARDIOVASCULAR
INTERVENTIONAL
12/15/2011
12/15/2016 DISEASES
CARDIOLOGY
OBSTETRICS AND
2/4/2011
2/4/2016 GYNECOLOGY
7/1/2011
P7740
ARZOUMAN, DAVID ALLEN, MD
P1622
N8608
P0164
ASAD, MUHAMMAD , MD
ASAJU, SUNDAY OLANREWAJU,
MD
ASEH, OMERINE YEMBE, MD
N1535
ASFOUR, ABEDELRAHIM, MD
N5539
ASGAONKAR, ANIL V, MD
4/9/2010
N4922
ASH, LORRAINE MARJORIE, DO
2/5/2010
N1536
P0165
N7772
ASHAM, EMAD HAKEEM, MD
ASHARAF, ABDULRASHEED, MD
ASHBY, KEITH MEREDITH, MD
N8757
P6776
N2386
M8509
ASHFAQUE, AMBREEN , MD
ASHRAF, ASMA , MD
ASHRAF, SYED SAUD, MD
ASHRITH, GUHA , MD
N9803
ASIEGBU, BENEDICT EMEKA, MD
6/3/2011
P6577
ASIROT, RECHELLE LOZANO, MD
5/15/2013
P2580
P1518
P5326
ASKENASY, ERIK PAUL, MD
ASLAM, MURAD , MD
ASOPA, AMIT, MD
4/2/2012
12/1/2011
2/1/2013
N9167
ASSANASEN, CHATCHAWIN , MD
PEDIATRIC
HEMATOLOGY/ONCOL
4/1/2016 OGY
PEDIATRICS
P7742
P1162
ATAEI, HOMAYOUN, MD
ATALLAH, GEORGE MICHEL, DO
P6132
ATALLAH, RABIH, MD
12/12/2008
12/12/2008
7/1/2011
10/1/2010
2/15/2011
6/3/2013
4/3/2009
5/15/2013
4/1/2011
8/30/2013
10/17/2011
4/12/2013
CARDIOVASCULAR
12/12/2013 DISEASES
FAMILY MEDICINE
FAMILY PRACTICE
INTERNAL MEDICINE
CARDIOLOGY
WACO
TX
INTERNAL MEDICINE
2/5/2015 RADIOLOGY
TRANSPLANT
12/12/2013 SURGERY
6/3/2016 PEDIATRICS
TUCSON
AZ
THE
WOODLANDS TX
INTERVENTIONAL
CARDIOLOGY
4/9/2015 NEPHROLOGY
2/15/2016
6/3/2018
4/3/2014
5/15/2018
Practice City
Registration
Status of
Practice
Texas
State
License
NEURORADIOLOGY
ACTIVE
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
LICENSE
ISSUED
12/29/2011 None
N/A
2/4/2011 None
7/27/2011 None
N/A
N/A
9/30/2009 None
N/A
4/9/2010 None
N/A
2/5/2010 None
N/A
1/2/2009 None
7/6/2011 None
10/19/2010 None
N/A
N/A
N/A
TX
FL
TX
DALLAS
DALLAS
HOSPITALIST
CHARLESTON
TX
TX
WV
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
NEONATOLOGY
POMONA
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
HOUSTON
COLON AND RECTAL
SURGERY
HOUSTON
AUSTIN
PAIN MANAGEMENT LEXINGTON
NJ
Page 19 of 300
Disciplinary
Status Date
9/9/2013 None
GENERAL SURGERY GALVESTON
HOSPITALIST
BARTOW
HUMBLE
PAIN MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
2/15/2011
6/10/2013
9/22/2009
7/12/2013
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
6/13/2011 None
N/A
TX
ACTIVE
6/14/2013 None
N/A
TX
TX
KY
ACTIVE
ACTIVE
ACTIVE
4/5/2012 None
12/7/2011 None
2/15/2013 None
N/A
N/A
N/A
SAN ANTONIO TX
ACTIVE
4/7/2011 None
N/A
SHREVEPORT LA
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
9/6/2013 None
10/18/2011 None
N/A
N/A
4/12/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6329
ATASHBAND, ARMITA , MD
5/1/2013
M5035
ATKINSON, DAVID LOUIS, MD
6/3/2011
N7054
ATKINSON, SIDNEY WRIGHT, MD
7/15/2010
P4543
ATLURI, SAI, MD
10/1/2012
N4924
2/5/2010
P2823
P2581
ATLURI, SUMITHA , MD
ATOLAGBE, ADEBAYO OLUFEMI,
MD
ATREY, VARTIKA , MD
P1445
ATRI, ASHUTOSH , MD
P6945
ATTIA, MINAH F, MD
N9804
ATWAL, MANINDERJIT KAUR, MD
AUGENSTEIN, ADAM CHRISTIAN,
MD
P2093
N6151
N0616
P5774
AUSTIN, NED ALVIN, MD
AVALOS MISHAAN, ANA MIRIAM,
MD
4/13/2012
4/2/2012
11/15/2011
6/14/2013
6/3/2011
2/10/2012
6/4/2010
5/1/2018 CARDIOLOGY
PEDIATRIC
6/3/2016 PSYCHIATRY
CHILD AND
ADOLESCENT
Practice City
ACTIVE
FORT WORTH TX
NEUROLOGY
GERIATRICS INTERNAL MEDICINE
PSYCHIATRY
HEMATOLOGY
6/4/2015 (PATHOLOGY)
3/15/2013
8/1/2013
4/8/2011
4/8/2016 PEDIATRICS
P7383
AVERY, RICHEL ZAYAS, MD
AVILA ACOSTA, ADRIANA JANETH,
MD
N9346
AVILA, JAMIE , MD
P4629
AVILA, LYDIA, MD
N3464
AWAB, AHMED , MD
8/21/2009
P7607
AWAN, RINA NAZIR, MD
8/15/2013
PULMONARY
CRITICAL CARE
8/21/2014 MEDICINE
CRITICAL CARE
8/15/2018 MEDICINE (IM)
N4266
AYALA GARCIA, LILLIAM ENID, MD
11/6/2009
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/3/2013 None
N/A
ACTIVE
LICENSE
ISSUED
6/13/2011 None
N/A
7/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
10/30/2012 None
N/A
2/5/2010 None
N/A
4/26/2012 None
4/23/2012 None
N/A
N/A
PHOENIX
DALLAS
AZ
TX
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/17/2011 None
N/A
6/14/2013 None
N/A
6/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
2/14/2012 None
N/A
6/4/2010 None
N/A
9/9/2008 None
N/A
3/15/2013 None
N/A
8/1/2013 None
N/A
4/8/2011 None
N/A
10/15/2012 None
N/A
11/19/2009 None
N/A
8/15/2013 None
N/A
12/7/2009 None
N/A
OBSTETRICS AND
6/3/2016 GYNECOLOGY
8/29/2008
10/15/2012
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
CARDIOLOGY
ADDICTION
PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
HEAD AND NECK
SURGERY
FORT WORTH TX
INTERNAL MEDICINE
PULMONARY
DISEASES
Page 20 of 300
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
P4845
N7212
P4544
AYALA, CARLOS, MD
AYALA, JOSE-RUBEN , MD
AYALLOORE, SIBY GEORGE, MD
N8483
AYDELOTTE, JAYSON DAVID, MD
P5329
AYENI, OLAYINKA MODUPE, MD
P6133
AYERS, GAYLE YVONNE, DO
N1986
P7063
AYERS, KARYN MARIE JESTER, MD
AYESTARAN CASSANI,
ALEJANDRA CRISTINA, MD
AYOOLA, FOLAHAN KOLAWOLE,
MD
AYOUB-RODRIGUEZ, LISA
MICHELLE, MD
N6153
AYUB, ASMA, MD
N7213
P2826
dicaid
dicaid
Agreement
End Date
Designated)
OTORHINOLARYNGOL
11/15/2012
11/15/2017 OGY
8/2/2010
10/1/2012
1/18/2011
2/1/2013
4/12/2013
Secondary Specialty
(Self-Designated)
Practice City
FACIAL PLASTIC
SURGERY
INTERNAL MEDICINE EL PASO
TX
INTERNAL MEDICINE
SURGICAL CRITICAL
1/18/2016 TRAUMATIC SURGERY CARE
SAN ANTONIO TX
CHILD AND
ADOLESCENT
2/1/2018 PSYCHIATRY
PSYCHIATRY
EL PASO
TX
2/6/2009
8/2/2010
8/2/2015 PEDIATRICS
4/13/2012
7/1/2018 PEDIATRICS
6/4/2010
AZAM, GHAZALA AHMED, MD
6/4/2010
P6330
N2391
AZHAR, AHSAN , MD
AZIZ, ASIF , MD
5/1/2013
4/3/2009
P2949
N4267
AZIZ, BUSHRA, MD
AZIZ, FATIMA , MD
P6331
AZIZ, NIVIN, MD
5/1/2013
P5589
P2190
AZIZ, SHAHID, MD
AZIZ, WESAM SABRI, MD
3/1/2013
3/1/2012
P5258
AZPURUA, FEDERICO EMILIO, MD
5/1/2012
11/6/2009
1/15/2013
HOSPITALIST
ACTIVE
LICENSE
ISSUED
ACTIVE
SAN ANGELO
TX
ACTIVE
LICENSE
ISSUED
EL PASO
TX
5/1/2018 PALLIATIVE MEDICINE INTERNAL MEDICINE HOUSTON
TX
SAN JOSE
CA
CHILD AND
ADOLESCENT
5/1/2017 PSYCHIATRY
PSYCHIATRY
CHARLESTON WV
5/1/2018 NEPHROLOGY
ENDOCRINOLOGY,
DIABETES AND
3/1/2018 METABOLISM
INTERVENTIONAL
ACTIVE
OK
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
6/4/2015 GYNECOLOGY
ACTIVE
ACTIVE
ACTIVE
OKLAHOMA
CITY
7/1/2013
N6154
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
11/19/2012 None
8/5/2010 None
12/3/2012 None
Disciplinary
Status Date
N/A
N/A
N/A
1/28/2011 None
SEE
PREVIOUS
2/22/2013 ORDER
N/A
4/12/2013 None
N/A
2/16/2009 None
N/A
8/9/2010 None
N/A
4/13/2012 None
N/A
7/19/2013 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
6/19/2013 None
5/18/2009 None
N/A
N/A
5/10/2012 None
12/17/2009 None
N/A
N/A
5/1/2013 None
N/A
3/1/2011
INTERNAL MEDICINE
ACTIVE
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE SAN ANTONIO TX
HOSPITALIST
HARLINGEN
TX
ACTIVE
ACTIVE
3/7/2013 None
3/6/2012 None
N/A
N/A
INTERNAL MEDICINE
ACTIVE
1/28/2013 None
N/A
Page 21 of 300
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P4732
AZUOGU, ONYEMEZE , MD
11/1/2012
P4415
BABADE, MOSUNMOLA , MD
9/17/2012
9/17/2017 PAIN MANAGEMENT
N9805
BABINEAUX, MICHAEL JAMES, MD
6/3/2011
N4927
BACH, HAROLD GREGORY, MD
2/5/2010
N7674
BACHIR, NATALIE MYRNA, MD
9/15/2010
P2950
BACKLUND, AMANDA JANINE, MD
5/1/2012
N4271
BADAWY, MOHAMED KARIM , MD
11/6/2009
N7903
10/15/2010
P7608
N0620
BADERO, OLUROTIMI JOHN, MD
BADI, ARUNKUMAR NARAYANSA ,
MD
BADIDI, OGHENETEGA ABRAHAM,
MD
BADIGER, MALLIKARJUN
PUNDLEEK, MD
BADIREDDY, MADHU SUDHAN
REDDY, MD
BADLISSI, JOHN KERRY, MD
P3115
BADLISSI, MICHAEL, MD
N3468
P5591
P1845
N9347
BADR, AHMED EBRAHIM, MD
L2118
P4416
P2951
N5544
BAG, REMZI, MD
BAGGETT, LISA R, MD
BAGRODIA, MONA AMBIKA, MD
BAH, ELIZABETH LEIGH, DO
N5545
BAHADORANI, JOHN NADER, MD
3/1/2013
1/17/2012
8/15/2013
8/29/2008
5/15/2012
4/9/2010
PULMONARY
DISEASES
ANESTHESIOLOGY
PEDIATRICS
FAMILY MEDICINE
ACTIVE
12/4/2012 None
N/A
PLANO
TX
ACTIVE
10/3/2012 None
N/A
GALVESTON
TX
ACTIVE
6/10/2011 None
N/A
N/A
9/15/2010 None
N/A
ACTIVE
5/14/2012 None
N/A
DALLAS
TX
ACTIVE
11/11/2009 None
N/A
ACTIVE
10/20/2010 None
N/A
LA
ACTIVE
10/1/2009 None
N/A
TX
ACTIVE
4/3/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
1/24/2012 None
N/A
8/15/2013 None
9/11/2008 None
N/A
N/A
5/15/2012 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
4/14/2011 None
N/A
2/1/2013
9/20/2012
6/28/2012
4/28/2010
None
None
None
None
N/A
N/A
N/A
N/A
4/9/2010 None
N/A
INTERNAL MEDICINE
NEDERLAND
Page 22 of 300
2/5/2010 None
TX
DALLAS
CARDIOLOGY
LICENSE
ISSUED
LICENSE
ISSUED
LUBBOCK
TX
EL PASO
TX
TEMPLE
CEDAR HILL
DALLAS
TX
TX
TX
CRITICAL CARE
MEDICINE
Disciplinary
Status Date
TX
NEPHROLOGY
OTOLOGY/NEUTOTO
LOGY
MONROE
CRITICAL CARE
ANESTHESIOLOGY
2/1/2018
9/17/2017
5/1/2017
4/9/2015
PEDIATRIC EMER
MED (PEDS)
Registration
Status Date
Disciplinary
Status of
Texas
License
EL PASO
ORTHOPEDIC
2/5/2015 SURGERY
GASTROENTEROLOG
9/15/2015 Y
INTERNAL MEDICINE
8/21/2009
2/1/2013
9/17/2012
5/1/2012
4/9/2010
Practice City
ORTHOPEDIC
SURGERY OF THE
SPINE
CARDIOVASCULAR
10/15/2015 DISEASES
OTOLARYN & FACIAL
4/8/2011
Secondary Specialty
(Self-Designated)
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
ANESTHESIOLOGY PAIN MANAGEMENT
Registration
Status of
Practice
Texas
State
License
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N7214
N9431
BAHMANPOUR, KAVEH , MD
BAIA, CATALINA, MD
8/2/2010
4/15/2011
N8485
N5546
BAIG, MIRZA NUSRUTULLAH, MD
BAIG, NAZIA , MD
1/18/2011
4/9/2010
P2191
BAILEY, APRIL ALEXANDER, MD
3/1/2012
P6135
BAILEY, ELIZABETH ANN, MD
4/12/2013
N4929
BAILEY, YVETTE, MD
2/5/2010
N4273
P6332
P5157
BAIRD, CHRISTOPHER WALLACE,
MD
BAIRD, TIFFANY RENEE, MD
BAKAJ, GENTIANA, MD
N1988
BAKER, ASHLEY ANN, MD
N4931
P7064
N9019
BAKER, MACARTHUR L., MD
BAKSHI, PRATIMA RAMESH, MD
BALAN, SUDHA, MD
P5930
BALAPALA, KIRANMAYE , MD
4/1/2013
N4276
BALCH, GLEN CHARLES, MD
11/6/2009
N8885
N7055
BALEZENTIS, SUSAN M, DO
BALIGA, CHRISTOPHER SURESH,
MD
N5547
BALL, TIMOTHY RYAN, MD
4/9/2010
P2954
BALLA, JUSTIN DOMINIQUE, MD
5/1/2012
P6582
BALLAPURAM, KALYANI, MD
11/6/2009
5/1/2013
1/4/2013
2/6/2009
2/5/2010
7/1/2013
3/15/2011
3/1/2011
7/15/2010
5/15/2013
NEUROLOGICAL
1/18/2016 SURGERY
4/9/2015 PEDIATRICS
DIAGNOSTIC
3/1/2017 RADIOLOGY
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
PEDIATRICS
Practice City
FONTANA
ARLINGTON
DALLAS
Registration
Status of
Practice
Texas
State
License
CA
TX
TX
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
2/5/2015 RADIOLOGY
PEDIATRIC
CARDIOTHORACIC
11/6/2014 SURGERY
THORACIC SURGERY
5/1/2018 PEDIATRICS
PEDIATRIC
HEMATOLOGY/ONCOL
2/6/2014 OGY
PEDIATRICS
CARDIOTHORACIC
ANESTHESIOLOGY
ANESTHESIOLOGY
GERIATRIC MEDICINE
4/1/2018 (INTERNAL MED)
FAMILY MEDICINE
SURGICAL
ABDOMINAL
11/6/2014 ONCOLOGY
SURGERY
EMERGENCY
3/1/2016 MEDICINE
INFECTIOUS
7/15/2015 DISEASES
INTERNAL MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Page 23 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
8/23/2010 None
4/28/2011 None
N/A
N/A
1/18/2011 None
4/16/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
3/12/2012 None
N/A
4/12/2013 None
N/A
2/5/2010 None
N/A
11/24/2009 None
5/17/2013 None
2/7/2013 None
N/A
N/A
N/A
3/11/2009 None
N/A
2/5/2010 None
7/9/2013 None
3/31/2011 None
N/A
N/A
N/A
LICENSE
ISSUED
DALLAS
MANSFIELD
GREENVILLE
TX
TX
NC
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
OAK LAWN
IL
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
GALVESTON
TX
ACTIVE
4/8/2013 None
N/A
DALLAS
TX
ACTIVE
11/17/2009 None
N/A
YONKERS
NY
ACTIVE
3/18/2011 None
N/A
HOUSTON
TX
ACTIVE
7/23/2010 None
N/A
TEMPLE
TX
ACTIVE
4/21/2010 None
N/A
HOUSTON
WICHITA
FALLS
TX
ACTIVE
5/7/2012 None
N/A
TX
ACTIVE
5/23/2013 None
N/A
License
Number
Physician Name
N6811
BALLARD, AMY MICHELLE, DO
P6779
BALLAS, JERASIMOS, MD
M2549
BALLESTAS, CARLOS ENRIQUE,
MD
N0625
N6158
N5549
BALLESTER, JOHN MICHAEL, MD
BALLIVIAN, ROBERTO
ALEJANDRO, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
7/1/2010
MATERNAL AND
OBSTETRICS AND
6/3/2013
6/3/2018 FETAL MEDICINE
GYNECOLOGY
GERIATRIC
MEDICINE (FAMILY
8/21/2009
PRACTICE)
EMERGENCY
8/29/2008
8/29/2013 MEDICINE
6/4/2010
P1446
11/15/2011
P5027
BANDA, PRAGATI, MD
12/17/2012
P5027
BANDA, PRAGATI, MD
12/17/2012
P5027
N8272
BANDA, PRAGATI, MD
BANDARU, HIMABINDU, MD
12/17/2012
12/15/2010
N5553
N4279
P5028
P5028
P5028
BANDI, SRIJAYA, MD
BANDYOPADHYAY, SUBHANKAR ,
MD
BANERJEE, KAKOLI, MD
BANGA, MADHUMITA, MD
2/4/2011
P2586
BANGALE, ANITA, MD
N0628
BANGALORE, DEEPA , MD
8/29/2008
N7774
N9506
BANGASH, AFFAAN KHAN, DO
BANKS, CRYSTAL LEIGH, MD
10/1/2010
5/2/2011
N4281
P6333
BANKS, KRISTINE ELIZABETH, MD
BANSAL, ARVIN, MD
11/6/2009
5/1/2013
4/9/2010
11/6/2009
12/17/2012
12/17/2012
12/17/2012
4/2/2012
PEDIATRIC EMER MED
4/9/2015 (PEDS)
EMERGENCY
4/2/2017 MEDICINE
CRITICAL CARE
TX
ACTIVE
7/1/2013 None
N/A
DALLAS
TX
ACTIVE
9/9/2009 None
N/A
MASON
OH
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/7/2008 None
N/A
6/4/2010 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
11/22/2011 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
12/31/2010 None
N/A
N/A
2/4/2011 None
N/A
INTERNAL MEDICINE PHILADELPHIA PA
FORTWORTH
TX
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
10/1/2015 RADIOLOGY
5/2/2016 PEDIATRICS
ORTHOPEDIC
11/6/2014 SURGERY
Page 24 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/12/2010 None
N/A
HOUSTON
6/4/2015 OTHER SPECIALTY
PEDIATRIC
4/9/2015 NEUROLOGY
BALMAKUND, TONYA MICHELE, MD
BALMER-SWAIN, MALLORY ANNE,
DO
N8612
4/9/2010
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
AUSTIN
SPRINGFIELD
SPRINGFIELD
SPRINGFIELD
FALLS
CHURCH
TX
IL
IL
IL
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
VA
ACTIVE
HOUSTON
TX
HOUSTON
HOUSTON
TX
TX
4/22/2010
1/11/2010
12/26/2012
12/26/2012
12/26/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
4/11/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
10/23/2008 None
N/A
10/1/2010 None
5/6/2011 None
N/A
N/A
ACTIVE
ACTIVE
12/31/2009 None
5/10/2013 None
N/A
N/A
License
Number
Physician Name
P7066
BANSAL, MANISH, MD
N9674
BANSAL, SHANTI LAL, MD
N7775
P4735
BANSAL, SONIA, MD
BANTU, VISHWAROOP, MD
N5554
N7056
BAO, JIANXIONG RICHARD, MD
BAPAT, VIJAY , MD
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRICS,
7/1/2013
7/1/2018 CARDIOLOGY
CARDIAC
ELECTROPHYSIOLOG
5/16/2011
5/16/2016 Y
EMERGENCY
10/1/2010
10/1/2015 MEDICINE
11/1/2012
ANATOMIC/CLINICAL
4/9/2010
4/9/2015 PATHOLOGY
7/15/2010
PEDIATRIC
GASTROENTEROLOG
2/15/2011
2/15/2016 Y
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
8/29/2008
RADIATION
10/15/2010
10/15/2015 ONCOLOGY
N8758
BARAD, ASHIS VANMALI, MD
N4932
N0631
BARAK, ORY, MD
BARAKAT, AYMAN , MD
N7904
BARANI, IGOR JOHAN, MD
P7385
N7216
BARBA, CARLOS ALBERTO, MD
BARBARO DIEBER, TINA GRACE,
MD
P6947
P0698
BARDWELL, STEVEN JOHN, DO
BARE, SUDHIR, MD
6/14/2013
8/15/2011
N4282
BAREKET, HENRY ZVI, MD
11/6/2009
8/1/2013
8/2/2010
8/2/2015 GENETICS
EMERGENCY
6/14/2018 MEDICINE
OBSTETRICS AND
DIAGNOSTIC
12/1/2015 RADIOLOGY
N8165
BARGE, JAIDEEP UDAY, MD
12/1/2010
N7675
N9350
BARIUAN, APRIL JOY GALVEZ, MD
BARKER, BLAKE R, MD
9/15/2010
4/8/2011
N3477
N3478
BARKER, COLIN MACLEOD , MD
BARKER, EMILY CHISM, MD
8/21/2009
8/21/2009
P2588
P7386
BARKER, JEFFREY RYAN, MD
BARKLEY, SHANNON, MD
4/2/2012
8/1/2013
INTERVENTIONAL
Secondary Specialty
(Self-Designated)
Practice City
PEDIATRICS
CARDIOLOGY
CYTOPATHOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
HOUSTON
TX
KALAMAZOO
MI
ACTIVE
LICENSE
ISSUED
ACTIVE
TEMPE
DALLAS
AZ
TX
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/1/2013 None
N/A
5/19/2011 None
N/A
10/1/2010 None
11/15/2012 None
N/A
N/A
4/27/2010 None
7/19/2010 None
N/A
N/A
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
2/15/2011 None
N/A
2/5/2010 None
11/19/2008 None
N/A
N/A
ACTIVE
10/25/2010 None
N/A
ACTIVE
8/9/2013 None
N/A
TX
ACTIVE
8/23/2010 None
N/A
FORT WORTH TX
INTERNAL MEDICINE ODESSA
TX
ACTIVE
ACTIVE
7/9/2013 None
8/18/2011 None
N/A
N/A
ACTIVE
1/11/2010 None
N/A
ACTIVE
12/21/2010 None
N/A
INTERNAL MEDICINE TULSA
OK
SAN
FRANCISCO
CA
TRAUMATIC
BROWNSVILL
SURGERY
E
TX
HOUSTON
SUFFERN
NY
INTERVENTIONAL
RADIOLOGY
CARDIOVASCULAR
DISEASES
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Page 25 of 300
WEBSTER
CHICAGO
TX
IL
ACTIVE
ACTIVE
9/20/2010 None
4/21/2011 None
N/A
N/A
HOUSTON
HOUSOTN
TX
TX
ACTIVE
ACTIVE
8/27/2009 None
8/27/2009 None
N/A
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
4/12/2012 None
8/13/2013 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N8486
BARKSDALE, ANTONIO DINO, MD
1/18/2011
P7244
P2415
BARNES, ARTI, MD
BARNES, JAMMIE KAY, MD
7/15/2013
3/15/2012
P6948
BARNES, MAISHA NICHOLE, MD
6/14/2013
P3286
P3118
BARNIDGE, MICHAEL JR, MD
BARNING, KENNETH , MD
6/1/2012
5/15/2012
N7392
BARRERA, ALEJANDRO DAVID, MD
8/16/2010
N3480
BARRERA, JOSE ENRIQUE, MD
8/21/2009
P5259
BARRETTO, JOHAN JUDE, MD
1/15/2013
N7676
BARTANUSZ, VIKTOR , MD
9/15/2010
N9170
4/1/2011
INFECTIOUS
7/15/2018 DISEASES
GASTROENTEROLOG
6/14/2018 Y
DIAGNOSTIC
6/1/2017 RADIOLOGY
OTOLARYN & FACIAL
P3507
N7776
BARTOSH, NICOLE SCHROCK, DO
10/1/2010
P6137
BASALDUA, KELLY MARIE, MD
4/12/2013
P5776
BASANI, SAMATA, MD
3/15/2013
ACTIVE
ACTIVE
7/23/2013 None
3/16/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/20/2013 None
N/A
6/1/2012 None
5/30/2012 None
N/A
N/A
ACTIVE
8/19/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/26/2009 None
N/A
1/15/2013 None
N/A
ACTIVE
10/29/2010 None
N/A
ACTIVE
4/13/2011 None
N/A
6/14/2012 None
N/A
10/11/2010 None
N/A
4/12/2013 None
N/A
3/15/2013 None
N/A
ACTIVE
4/8/2009 None
N/A
SPRINGFIELD IL
ACTIVE
2/7/2012 None
N/A
FT. BLISS
TX
HOUSTON
TX
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
8/12/2011 None
12/6/2010 None
2/18/2013 None
N/A
N/A
N/A
HOUSTON
LUFKIN
ACTIVE
ACTIVE
5/24/2013 None
9/21/2010 None
N/A
N/A
TX
TX
SAN ANTONIO TX
SAN ANTONIO TX
BEAUMONT
TX
ACTIVE
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
HOSPITALIST
N2397
BASHIR, QAISER , MD
4/3/2009
P1962
BASLER, JOSEPH THEODORE, MD
2/1/2012
P0341
N8166
P5509
BASSETT, ROBERT, DO
BASSETT, SCOTT TAYLOR, MD
BASSEY, UKANA, DO
7/15/2011
12/1/2010
2/8/2013
N3485
N7677
BASSHAM, BRIAN SCOTT, MD
BASSIN, ALAN SCOTT, MD
5/1/2013
9/15/2010
2/1/2017 RADIOLOGY
EMERGENCY
7/15/2016 MEDICINE
PEDIATRIC
EMERGENCY
5/1/2018 MEDICINE (PEDS)
HEMATOLOGY/ONCO
LOGY
PEDIATRICS
Page 26 of 300
Disciplinary
Status Date
N/A
HARLINGEN
SLEEP MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
1/18/2011 None
INTERNAL MEDICINE MINNEAPOLIS MN
INTERVENTIONAL
RADIOLOGY
PASADENA
TX
DERMATOLOGIC
SURGERY
EMERGENCY
MEDICINE
EMERGENCY
6/8/2017 MEDICINE
Practice City
INTERNAL MEDICINE DALLAS
NEUROLOGICAL
9/15/2015 SURGERY
BARTELL, HOLLY LEIGH, MD
BARTON, JAMES BRADLEY
GUSTAF, MD
6/8/2012
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
TX
License
Number
Physician Name
N4936
N3486
BATCHELOR, KRYSTAL RENAE, DO
BATCHU, VISHALAKSHMI , MD
N5558
P2589
BATHALA, ELIZABETH, MD
BATHALA, THARAKESWARA
KUMAR, MD
P6584
dicaid
dicaid
Agreement
End Date
Designated)
2/5/2010
8/21/2009
4/9/2010
2/5/2015 PEDIATRICS
DIAGNOSTIC
4/9/2015 RADIOLOGY
4/2/2017 RADIOLOGY
BATISTA, DALIA L, MD
5/15/2013
P6138
BATRA, KIRAN, MD
4/12/2013
4/12/2018 RADIOLOGY
N6162
BATTLES, KRISTEN ANN, DO
N3488
BAUER, BRENT J, MD
8/21/2009
ORTHOPEDIC
8/21/2014 TRAUMA
N2935
5/29/2009
5/29/2014 UROLOGY
7/1/2013
7/1/2018 ALLERGY
N5562
BAUM, LAWRENCE OWEN III, MD
BAUMGARTNER, EDWARD
WILLIAM JR, MD
BAVARE, CHARUDATTA SHRIKANT,
MD
P6585
BAXTER, AARON JAMES, MD
5/15/2013
DIAGNOSTIC
5/15/2018 RADIOLOGY
P1447
BAYASI, MOHAMMED , MD
11/15/2011
P7067
4/9/2010
UROLOGIC SURGERY HOUSTON
ANESTHESIOLOGY PAIN MANAGEMENT HOUSTON
SURGICAL CRITICAL
CARE
INTERVENTIONAL
RADIOLOGY
HOUSTON
BAYAT, NEYSAN, MD
N7522
BAYRAKTAR, SOLEY , MD
N5563
BAYRAKTAR, ULAS DARDA, MD
N4287
P0544
BEADLE, SARAH MAY, MD
BEAN, GARY ERWIN, MD
BEARD, HEATHER LEANNE
NORRIS, DO
11/6/2009
8/1/2011
1/17/2012
HEMATOLOGY/ONCO
8/27/2015 INTERNAL MEDICINE LOGY
HEMATOLOGY/ONCOL
4/9/2015 OGY
INTERNAL MEDICINE
EMERGENCY
11/6/2014 MEDICINE
8/1/2016 PEDIATRICS
EMERGENCY
1/17/2017 MEDICINE
BEARDWOOD, GORDON ALAN, MD
BEAUCHAMP, BRANDY LA'SHAY,
MD
8/21/2009
11/6/2009
N3489
N4288
8/27/2010
4/9/2010
HOUSTON
PLANO
P4926
P1848
11/30/2012
Practice City
HOUSTON
CORPUS
CHRISTI
DIAGNOSTIC
RADIOLOGY
4/2/2012
6/4/2010
Secondary Specialty
(Self-Designated)
HAND SURGERY
PAIN MEDICINE
Page 27 of 300
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
9/4/2009 None
N/A
N/A
4/19/2010 None
N/A
4/9/2012 None
N/A
5/15/2013 None
N/A
4/12/2013 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
9/3/2009 None
N/A
TX
ACTIVE
6/26/2009 None
N/A
TX
ACTIVE
7/12/2013 None
N/A
ACTIVE
4/14/2010 None
N/A
ACTIVE
LICENSE
ISSUED
5/17/2013 None
N/A
11/15/2011 None
N/A
TX
PORT
ARTHUR
TX
ACTIVE
HOUSTON
TX
MIAMI
DALLAS
N/A
ACTIVE
12/7/2012 None
SEE
PREVIOUS
9/9/2010 ORDER
FL
ACTIVE
4/26/2010 None
N/A
TX
ACTIVE
ACTIVE
12/23/2009 None
8/5/2011 None
N/A
N/A
FORT WORTH TX
ACTIVE
2/24/2012 None
N/A
AUSTIN
ACTIVE
LICENSE
ISSUED
8/26/2009 None
N/A
11/6/2009 None
N/A
TX
8/30/2010
dicaid
dicaid
License
Agreement
Agreement Primary Specialty (SelfNumber
Physician Name
Start Date
End Date
Designated)
EMERGENCY
P6336
BECK, ERIC HENRY, DO
5/1/2013
5/1/2018 MEDICINE
PEDIATRIC
P1048
BECKER, EMILY MARIE, MD
10/3/2011
ENDOCRINOLOGY,
DIABETES AND
N4939
BECKER, JOSEPH RICHARD, MD
2/5/2010
2/5/2015 METABOLISM
PEDIATRICS,
P4419
BECKER, JUDITH ANNE, MD
9/17/2012
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
THORACIC
CARDIOVASCULAR
N6167
BECKLES, DANIEL LINCOLN, MD
6/4/2010
6/4/2015 SURGERY
BECKUM, ORLANDO KENDRICK,
EMERGENCY
P3121
MD
5/15/2012
5/15/2017 MEDICINE
N8613
BEDNARSKI, KAREN ANNE, MD
2/4/2011
PEDIATRIC
P5932
BEDRI, BADRELDIN, MD
4/1/2013
4/1/2018 NEPHROLOGY
N5564
BEENE, CHRISTOPHER LEE, MD
4/9/2010
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
P4848
BEG, HUMAYUN, MD
11/15/2012
N7393
BEGUM, MAHMUDA , MD
8/16/2010
P5777
P5334
BEH, SHIN CHIEN, MD
BEHZADI, CHRISTEN FLACK, MD
3/15/2013
2/1/2013
P5335
BEHZADI, PEDRAM AMIN, MD
2/1/2013
P2096
BEICKER, CLINT ROYAL, MD
2/10/2012
3/15/2018 NEUROLOGY
EMERGENCY
2/1/2018 MEDICINE
ORTHOPEDIC
2/10/2017 SURGERY
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICAL SERVICES
Practice City
DALLAS
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
TX
ACTIVE
6/26/2013 None
N/A
SAN ANTONIO TX
ACTIVE
10/9/2011 None
N/A
2/5/2010 None
N/A
LICENSE
ISSUED
INTERNAL MEDICINE
HOUSTON
TX
ACTIVE
10/24/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
12/25/2009 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
5/15/2012 None
2/11/2011 None
N/A
N/A
4/1/2013 None
4/26/2010 None
N/A
N/A
THORACIC SURGERY
RALEIGH
NC
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
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
CEDAR PARK
TX
8/1/2011 None
11/20/2012 None
8/31/2010 None
N/A
N/A
N/A
ROCHESTER
NY
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
3/15/2013 None
2/6/2013 None
N/A
N/A
GENEVA
NY
ACTIVE
2/5/2013 None
N/A
LUBBOCK
TX
ACTIVE
2/20/2012 None
N/A
NEUROOPHTHALMOLOGY
Page 28 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PLASTIC &
RECONSTRUCTIVE
3/1/2012
3/1/2017 SURGERY
P2194
BEIDLER, STEPHANIE KATHRYN,
MD
N6168
BEITINJANEH, AMER, MD
6/4/2010
P6781
BEJJANI, CARLA, MD
6/3/2013
6/3/2018 PSYCHIATRY
P1850
BEKANICH, STEPHEN JAMES, MD
N4941
BEKELE, MEAZA TILAHUN, MD
1/17/2012
2/5/2010
P0344
BEKHEIRNIA, MIR REZA , MD
7/15/2011
N8167
BELANGER, THEODORE ANDREW,
MD
12/1/2010
P1165
P4632
BELCHER, MEGAN ELIZABETH, DO
BELL, JACQUELINE MARIE, DO
10/17/2011
10/15/2012
P2590
BELL, MEGAN E, MD
N9352
N9675
BELL, TODD DWAYNE, MD
BELLARD, BOBBY JOSEPH, MD
4/8/2011
5/16/2011
P4420
BELO, ANGELICA CHIOMA, MD
9/17/2012
P2416
BELTRAMINI, ERIN WEUST, DO
3/15/2012
4/2/2012
P5933
P2591
P2956
BELTRAN, MICHAEL JOHN, MD
BELZ, GLENN ROLAND, MD
BENDER, NATHAN SCOTT, MD
4/1/2013
4/2/2012
5/1/2012
P5336
P4547
BENDURE, ERIN O'NEILL, MD
BENFOLD, NICOLE , MD
2/1/2013
10/1/2012
P7246
N7523
P7247
BENGLIS, DAVID MICHAEL JR, MD
BENITEZ, ADOLFO L, MD
BENJAMIN, BIJAS , MD
7/15/2013
8/27/2010
7/15/2013
Secondary Specialty
(Self-Designated)
Practice City
CHAPEL HILL
HEMATOLOGY/ONCO
LOGY
GERIATRIC
PSYCHIATRY
HOUSTON
PALLIATIVE
MEDICINE
MIAMI
Registration
Status of
Practice
Texas
State
License
NC
Disciplinary
Status Date
3/13/2012 None
N/A
6/4/2010 None
N/A
6/4/2013 None
N/A
TX
ACTIVE
FL
ACTIVE
LICENSE
ISSUED
1/20/2012 None
N/A
2/5/2010 None
N/A
2/5/2015 PEDIATRICS
7/15/2016 CLINICAL GENETICS
ORTHOPEDIC
SURGERY OF THE
12/1/2015 SPINE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
CLINICAL
MOLECULAR
GENETICS
HOUSTON
TX
ACTIVE
7/25/2011 None
N/A
ORTHOPEDIC
SURGERY
ROCKWALL
TX
ACTIVE
12/3/2010 None
N/A
SUGAR LAND
BEDFORD
TX
TX
ACTIVE
ACTIVE
10/26/2011 None
12/28/2012 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
4/26/2012 None
N/A
FORT HOOD
HOUSTON
TX
TX
ACTIVE
ACTIVE
4/13/2011 None
6/7/2011 None
N/A
N/A
MARSHALL
TX
ACTIVE
9/19/2012 None
N/A
ACTIVE
3/23/2012 None
N/A
DIAGNOSTIC
INTERVENTIONAL
4/2/2017 RADIOLOGY
RADIOLOGY
EMERGENCY
4/8/2016 MEDICINE
GASTROENTEROLOG
9/17/2017 Y
INTERNAL MEDICINE
OBSTETRICS AND
ORTHOPEDIC
4/1/2018 SURGERY
4/2/2017 PSYCHIATRY
PEDIATRIC
EMERGENCY
2/1/2018 PEDIATRICS
MEDICINE (PEDS)
NEUROLOGICAL
7/15/2018 SURGERY
Page 29 of 300
FORT SAM
HOUSTON
HOUSTON
SUGAR LAND
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/29/2013 None
4/27/2012 None
5/3/2012 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
ACTIVE
2/7/2013 None
10/22/2012 None
N/A
N/A
ATLANTA
EL PASO
DALLAS
GA
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/26/2013 None
9/1/2010 None
7/17/2013 None
N/A
N/A
N/A
License
Number
Physician Name
N9511
BENJAMIN, ELIZABETH R, MD
N0642
N5566
P7392
P5512
P4930
BENNETT, ROBERT DANIEL, MD
BENTON, CHRISTOPHER BRENT,
MD
BENTON, EDWARD GARRISON JR,
MD
BENTON, MARIA FLORENCIA, MD
BENVENISTE, MARCELO
KUPERMAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
5/2/2011
CARDIOVASCULAR
8/29/2008
8/29/2013 SURGERY
4/9/2010
8/1/2013
2/8/2013
11/30/2012
P4421
BENZ, MICHAEL, MD
N5567
BERG, BRADLEY ROSS, MD
4/9/2010
P2593
BERG, ERIC E, MD
4/2/2012
P6337
BERG, KRISTIN MARIE, MD
5/1/2013
N6173
BERG, MARY JEAN, MD
6/4/2010
N2942
BERGBAUER, ROBIN , MD
N9512
P5034
P5034
P5034
N3492
BERGER, TODD JASON, MD
BERJE, ALBERT, MD
BERJE, ALBERT, MD
BERJE, ALBERT, MD
BERLIN, ALEXANDER LEON, MD
N4292
P5338
P7071
BERLINER, JEFFREY CRAIG, DO
BERMUDEZ POUCHARD, ELSIE
YAMILE, MD
BERMUDEZ, CHRISTOPHER
JOSEPH, MD
9/17/2012
5/29/2009
5/2/2011
12/17/2012
12/17/2012
12/17/2012
8/21/2009
11/6/2009
ORTHOPEDIC
8/1/2018 SURGERY
DIAGNOSTIC
CARDIOVASCULAR
9/17/2017 DISEASES
EMERGENCY
5/2/2016 MEDICINE
PHYSICAL MED. &
7/1/2013
DIAGNOSTIC
7/1/2015 RADIOLOGY
7/1/2010
P1727
P7072
BERRY, SHANNON GAYLE, MD
BERRY, THOMAS JOEL, MD
1/2/2012
7/1/2013
SHERMAN
TX
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
6/7/2011 None
N/A
11/13/2008 None
N/A
4/9/2010 None
N/A
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
WACO
HEMATOLOGY/ONCO
LOGY
HOUSTON
TX
ACTIVE
8/6/2013 None
N/A
TX
ACTIVE
2/12/2013 None
N/A
HOUSTON
TX
ACTIVE
12/13/2012 None
N/A
JERSEY CITY
NJ
ACTIVE
LICENSE
ISSUED
10/22/2012 None
N/A
4/9/2010 None
N/A
ACTIVE
4/9/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/8/2013 None
N/A
6/4/2010 None
N/A
INTERVENTIONAL
CARDIOLOGY
4/9/2015 PEDIATRICS
OTORHINOLARYNGOL
4/2/2017 OGY
EMERGENCY
5/1/2018 MEDICINE
FAMILY PRACTICE 6/4/2015 EMERGENCY MED
2/1/2018 PSYCHIATRY
BERNSTEIN, MARC ALAN, MD
Practice City
2/1/2013
N6815
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
ACTIVE
HUMBLE
CARDIOTHORACIC
ANESTHESIOLOGY
SPINAL CORD
INJURY MEDICINE
INTERVENTIONAL
RADIOLOGY
EMERGENCY MED
ANESTHESIOLOGY
Page 30 of 300
TX
GAINESVILLE
FL
ACTIVE
7/27/2009 None
N/A
AUSTIN
TX
ARLINGTON
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
5/5/2011
1/1/2013
1/1/2013
1/1/2013
8/28/2009
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
11/20/2009 None
N/A
2/5/2013 None
N/A
7/1/2013 None
N/A
ACTIVE
7/14/2010 None
N/A
ACTIVE
ACTIVE
2/28/2012 None
7/3/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ROCKFROD
IL
FORT WORTH TX
BELLAIRE
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N9354
BERRYHILL, WAYNE EDWARD, MD
4/8/2011
N6816
BERTORELLI, LUKE, DO
7/1/2010
N7221
BERZOSA CORELLA, MANUEL , MD
TM00463 BESSETTE, PETER RICHARD, MD
8/2/2010
8/15/2011
EMERGENCY
7/1/2015 MEDICINE
BESSLER, ROBERT AARON, MD
4/3/2009
P1964
N3497
P3288
BEST, AARON PATRICK, MD
BETANCO, JORGE ANTONIO, MD
BETTY, IRMA ELENA, MD
2/1/2012
8/21/2009
6/1/2012
P6141
BEVAN, CATHERINE IRENE, MD
4/12/2013
6/1/2017 PEDIATRICS
OBSTETRICS AND
N7395
BEVELS, GREGORY STEFAN, MD
8/16/2010
P2595
BEVINAL, MANZOOR AHAMED, MD
3/15/2011
GASTROENTEROLOG
Y
HOUSTON
8/15/2016 RADIOLOGY
EMERGENCY
4/3/2014 MEDICINE
N2404
4/2/2012
Secondary Specialty
(Self-Designated)
Practice City
OTOLOGY/NEUTOTO
LOGY
NORMAN
AUBURN
Registration
Status of
Practice
Texas
State
License
OK
TX
WA
SAN ANTONIO TX
EL PASO
TX
OBSTETRICS AND
GYNECOLOGY
DALLAS
TX
ADOLESCENT
MEDICINE - PD
4/27/2011 None
N/A
7/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/23/2010 None
N/A
8/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
4/24/2009 None
N/A
2/1/2012 None
9/1/2009 None
6/6/2012 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/18/2013 None
N/A
8/16/2010 None
N/A
4/2/2012 None
N/A
3/15/2011 None
N/A
12/17/2012 None
N/A
P5035
BEYENE, TESFAYE KEBEDE, MD
12/17/2012
P5035
12/17/2012
NEWPORT
AR
ACTIVE
1/14/2013 None
N/A
P5035
12/17/2012
NEWPORT
AR
N/A
BEZEK, SARAH KATHLEEN, MD
ACTIVE
LICENSE
ISSUED
1/14/2013 None
N6176
6/4/2010 None
N/A
P4633
N9677
P6143
BEZWADA, VISHNU VINOD, MD
BHADKAMKAR, NISHIN ANIL, MD
BHADRIRAJU, SATISH, MD
EMERGENCY
6/4/2015 MEDICINE
PULMONARY
CRITICAL CARE
10/15/2017 MEDICINE
5/16/2016 ONCOLOGY
LICENSE
ISSUED
ACTIVE
ACTIVE
10/15/2012 None
5/24/2011 None
4/26/2013 None
N/A
N/A
N/A
N4947
BHADRIRAJU, SRINIVAS, MD
LICENSE
ISSUED
2/5/2010 None
N/A
N4293
BHAKTA, NEETA SOORYA, MD
11/18/2009 None
N/A
2/5/2010
11/6/2009
EMERGENCY
11/6/2014 MEDICINE
SLEEP MEDICINE
NEWNAN
PULMONARY
CRITICAL CARE
MEDICINE
EMERGENCY
MEDICINE
TEMPLE
Page 31 of 300
TX
ACTIVE
LICENSE
ISSUED
BEYDA, REBECCA MONK, MD
10/15/2012
5/16/2011
4/12/2013
HOUSTON
Disciplinary
Status Date
N9023
6/4/2010
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
GA
TX
ACTIVE
License
Number
N5572
Physician Name
BHAKTHAVATSALAM,
HEMAVATHY, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/9/2010
3/15/2012
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
INTERVENTIONAL
CARDIOLOGY
P2417
BHANDARI, ANGELINA DEVI, MD
N5573
BHARGAVA, SANJAY, MD
4/9/2010
N7605
BHASKARA, SRIDHAR, MD
9/1/2010
P1166
BHAT, ASHWINI, MD
P7744
BHAT, PRADEEP KRISHNA, MD
P1201
BHAT, UDAYA M, MD
N7058
BHATT, AMIT RAKESH, MD
7/15/2010
P0347
BHATT, ANAND BIPIN, MD
7/15/2011
N4295
P0958
BHATT, NAYAN KUMAR, MD
BHATTARAI, SUMIT, MD
11/6/2009
9/15/2011
INTERVENTIONAL
P2196
N2949
BHATTI, MAQSOOD AHMED, MD
BHATTI, MEENU SINGH , MD
3/1/2012
5/29/2009
N8763
BHATTI, NADEEM HANIF, MD
2/15/2011
N6179
BHAVAN, KAVITA P, MD
INFECTIOUS
6/4/2015 DISEASES
10/17/2011
8/30/2013
10/17/2011
6/4/2010
9/17/2012
CARDIOVASCULAR
4/9/2015 DISEASES
ANESTHESIOLOGY 9/1/2015 PAIN MANAGEMENT
PAIN MANAGEMENT
HEMATOLOGY/ONCOL
10/17/2016 OGY
PULMONARY
CRITICAL CARE
10/17/2016 MEDICINE
PEDIATRIC
P4422
BHAVSAR, JENNIFER, MD
P3509
BHAVSAR, ROBIN RASHMI, MD
P4548
BHAVSAR, SHRIPAL KANTILAL, MD
10/1/2012
6/8/2017 UROLOGY
RADIATION
10/1/2017 ONCOLOGY
P0007
BHIMARAJ, ARVIND, MD
6/15/2011
N4297
BHODA, RAJA SEKHAR REDDY, MD
11/6/2009
6/8/2012
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
OPHTHALMOLOGY
OPHTHALMOLOGY GLAUCOMA
CARDIOVASCULAR
DISEASES
NC
ACTIVE
4/26/2010 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
LICENSE
ISSUED
3/21/2012 None
N/A
4/9/2010 None
N/A
PEORIA
IL
ACTIVE
10/14/2010 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
10/25/2011 None
N/A
8/30/2013 None
N/A
MOUNT
LAUREL
NJ
ACTIVE
10/26/2011 None
N/A
HOUSTON
TX
ACTIVE
7/21/2010 None
N/A
ACTIVE
7/25/2011 None
N/A
ACTIVE
ACTIVE
12/14/2009 None
12/7/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/12/2012 None
6/8/2009 None
N/A
N/A
2/15/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/19/2012 None
N/A
6/8/2012 None
N/A
ACTIVE
10/12/2012 None
N/A
DALLAS
INFECTIOUS
DISEASES
TX
HOQUIAM
WA
ROUND ROCK TX
PSYCHIATRY
COLLEGE
STATION
Disciplinary
Status Date
HENDERSON
INTERNAL MEDICINE
SLEEP MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
UROLOGIC SURGERY
THERAPEUTIC
RADIOLOGY
CARDIOVASCULAR
DISEASES
HOUSTON
TX
ACTIVE
6/20/2011 None
N/A
FAMILY MEDICINE
TX
ACTIVE
11/17/2009 None
N/A
Page 32 of 300
HUMBLE
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
N0648
Physician Name
BHOOPAL, JAIDEV RAGHURAM,
MD
P0008
BHULLAR, SHAMINDER SINGH, MD
N6817
P0348
P7394
BHUSAL, YOGESH , MD
BHUSARI, VAISHALI KAWADUJI,
MD
BHUTTA, SIDRA M, MD
7/15/2011
8/1/2013
N9434
BIBOA, JOHN CLEMENT, DO
4/15/2011
P6588
BICKETT, MELISSA MAE, MD
5/15/2013
INTERNAL MEDICINE
ORTHOPEDIC
SURGERY
P6951
BIDROS, DANI SIROP, MD
6/14/2013
SPORTS MEDICINE
5/15/2018 (ORTH SURG)
NEUROLOGICAL
6/14/2018 SURGERY
P3290
N0651
P2958
BIETZ, GABRIEL JACKSON, MD
BILKIS, SAYEEDA , MD
BILLATOS, EHAB , MD
6/1/2012
8/29/2008
5/1/2012
GENERAL VASCULAR
6/1/2017 SURGERY
VASCULAR
SURGERY
N1555
BILLINGSLEY, TRAVIS ALLEN, MD
P6338
BILLUE, DAVID CLAYTON, MD
5/1/2013
P1728
BIRKHOLZ, CHRISTOPHER , MD
1/2/2012
8/29/2008
6/15/2011
INFECTIOUS
7/1/2015 DISEASES
7/1/2010
12/12/2008
N3503
N4299
P5260
BIRNBAUM, LEE ALBERT, MD
BIRT, BRADLEY BLAIR, MD
BISEN, AJIT KUMAR, MD
8/21/2009
11/6/2009
1/15/2013
P4549
BISHOP, DENNIS MICHAEL, MD
10/1/2012
P2198
BLACK, DALLIAH MASHON, MD
3/1/2012
P1523
N5512
BLACK, JAMES EDWARD JR, MD
BLACKBURN, MATTHEW , DO
BLACKWELDER, JOHN TIMOTHY,
MD
N4300
12/1/2011
4/9/2010
11/6/2009
HOSPITALIST
Registration
Status of
Practice
Texas
State
License
Practice City
NACOGDOCH
ES
TX
OBSTETRICS AND
5/1/2018 GYNECOLOGY
OBSTETRICS AND
1/2/2017 GYNECOLOGY
PRINCETON
PECOS
DALLAS
NEONATOLOGY
8/21/2014 NEUROLOGY
11/6/2014 RADIOLOGY
EMERGENCY
10/1/2017 MEDICINE
SURGICAL BREAST
3/1/2017 ONCOLOGY
EMERGENCY
12/1/2016 MEDICINE
DIAGNOSTIC
11/6/2014 RADIOLOGY
VASCULAR
NEUROLOGY
HOSPITALIST
BREAST IMAGING
Page 33 of 300
Disciplinary
Status Date
ACTIVE
9/17/2008 None
N/A
LICENSE
ISSUED
6/15/2011 None
N/A
TX
ACTIVE
7/12/2010 None
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/25/2011 None
8/16/2013 None
N/A
N/A
4/15/2011 None
N/A
5/15/2013 None
N/A
NJ
ACTIVE
6/24/2013 None
N/A
TX
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
6/1/2012 None
9/10/2008 None
5/3/2012 None
N/A
N/A
N/A
ACTIVE
1/19/2009 None
N/A
ACTIVE
5/9/2013 None
N/A
ACTIVE
1/6/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
8/27/2009 None
12/9/2009 None
1/22/2013 None
N/A
N/A
N/A
ACTIVE
10/15/2012 None
N/A
OPHTHALMOLOGY VITREOUS SURGERY
WICHITA
HOSPITALIST
FALLS
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
GALVESTON TX
GUNTERSVILL
E
AL
SAN ANTONIO TX
HOUSTON
TX
LEBANON
PA
HOUSTON
TX
ACTIVE
3/16/2012 None
N/A
HOUSTON
WACO
TX
TX
ACTIVE
ACTIVE
2/17/2012 None
4/13/2010 None
N/A
N/A
ACTIVE
1/1/2010 None
N/A
WALLA WALLA WA
License
Number
Physician Name
N4301
P5158
BLACKWELL, SEAN CYLE, MD
BLAIR, MICHAEL , MD
N9813
P3510
BLAKE, BRIAN KELLY, DO
BLAKE, PATRICK WILLIAM, MD
P2596
P0009
BLAKKOLB, CHRISTI LYNN, MD
BLANCO, GABRIELA M, MD
P4424
P0815
BLANKENSHIP, ALAN LANE JR, MD
BLECHACZ, BORIS ROMAN
ALEXANDER, MD
P2098
BLIEDEN, LAUREN SASHA, MD
dicaid
dicaid
Agreement
End Date
Designated)
MATERNAL AND
11/6/2009
1/4/2013
EMERGENCY
6/3/2011
6/3/2016 MEDICINE
6/8/2012
PLASTIC &
RECONSTRUCTIVE
4/2/2012
4/2/2017 SURGERY
6/15/2011
EMERGENCY
9/17/2012
9/17/2017 MEDICINE
GASTROENTEROLOG
8/26/2011
8/26/2016 Y
2/10/2012
Secondary Specialty
(Self-Designated)
OBSTETRICS AND
GYNECOLOGY
GASTROENTEROLOG
8/21/2014 Y
INTERNAL MEDICINE
5/1/2018 RADIOLOGY
PREVENTIVE
MEDICINE
PULMONARY
CRITICAL CARE
4/1/2018 MEDICINE
INTERNAL MEDICINE
SPORTS MEDICINE
4/3/2014 (FAMILY PRACTICE)
HEMATOLOGY/ONCO
8/21/2009
5/1/2013
N3505
BLOUNT, BENROE WAYNE, MD
8/21/2009
P5934
BLOW, BENJAMIN JAMES, MD
4/1/2013
N2407
4/3/2009
N3507
BLUEITT, DAMOND , MD
BLUM MARIDUENA, MARIELA
ANABEL, MD
N9814
BLUNCK, JOSHUA THOMAS, DO
6/3/2011
P5597
BLYSTRA, ADAM CALVIN, DO
3/1/2013
6/3/2016 RADIOLOGY
EMERGENCY
3/1/2018 MEDICINE
N8888
BOAHENE, DEREK KOFI OWUSU,
MD
3/1/2011
OTORHINOLARYNGOL OTOLARYN & FACIAL
3/1/2016 OGY
PLASTIC SURGERY
P2831
BOCIRNEA, CRISTINA, MD
F5838
BODE, JOHN NICHOLAS, DO
N8766
BOE, RUTH , MD
11/30/2012
2/15/2011
4/13/2017 GERIATRICS
DIAGNOSTIC
TX
TX
Disciplinary
Status Date
TX
DALLAS
TX
ACTIVE
ACTIVE
4/6/2012 None
6/20/2011 None
N/A
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
9/24/2012 None
N/A
8/26/2011 None
N/A
ACTIVE
2/17/2012 None
N/A
ACTIVE
ACTIVE
9/2/2009 None
5/22/2013 None
N/A
N/A
ACTIVE
9/28/2009 None
N/A
TX
ACTIVE
4/4/2013 None
N/A
FORT WORTH TX
ACTIVE
4/24/2009 None
N/A
ACTIVE
LICENSE
ISSUED
9/28/2009 None
N/A
6/3/2011 None
N/A
ACTIVE
3/18/2013 None
N/A
3/1/2011 None
N/A
4/13/2012 None
N/A
12/11/2012 None
N/A
2/15/2011 None
N/A
LACKLAND
AFB
TX
AUSTIN
TX
FREDERICKSB
URG
TX
HOUSTON
HOUSTON
TX
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
Page 34 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
HEPATOLOGY
BLONSKY, JEFFERY J, MD
BLOOM, DANIEL GORDON, MD
4/13/2012
HOUSTON
ARLINGTON
N3504
P6340
8/21/2009
Practice City
Registration
Status of
Practice
Texas
State
License
PHOENIX
AZ
ACTIVE
LICENSE
ISSUED
11/13/2009 None
1/7/2013 None
N/A
N/A
6/3/2011 None
6/14/2012 None
N/A
N/A
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
Practice City
GASTROENTEROLOG
N7398
BOEHMKE, JAMES JOSEPH JR, DO
8/16/2010
8/16/2015 Y
INTERNAL MEDICINE
PLASTIC &
BOEHMLER, JAMES HERBERT IV,
RECONSTRUCTIVE
M6054
MD
8/15/2013
8/15/2018 SURGERY
PLASTIC SURGERY
COLUMBUS
OBSTETRICS AND
N4951
BOGAN, TIFFANY N, MD
2/5/2010
2/5/2015 GYNECOLOGY
SURGICAL CRITICAL
P5936
BOGERT, JAMES NATHANIEL, MD
4/1/2013
4/1/2018 GENERAL SURGERY CARE
HOUSTON
N8378
P0552
BOGOSSIAN, DEBRA ANNE, MD
BOHN, SARAH BETH, MD
N9679
BOLAND, GENEVIEVE MARIE, MD
N2009
BOLAND, PAMELA GRAY, MD
N8275
N2010
BOLANOS, KARLA PATRICIA, MD
BOLAR, SUDHIR NARAYANA, MD
P1271
N8169
BOLD, JONATHAN WYATT, MD
BOLDT, DAVID WARREN, MD
N2410
BOLLINENI, SRINIVAS , MD
N0655
BOLLINGER, ROBERT ALBIN II, DO
8/29/2008
P0701
BOLLO, ROBERT JOHN, MD
8/15/2011
P3124
BOLSON, RAJSHRI MAHESHWARI,
MD
5/15/2012
P2959
BOLT, KATHERINE , MD
N4953
N4304
BOLTON, RYSCHELL RENEE, DO
BOLZ, ANGELA DENE', DO
1/3/2011
8/1/2011
5/16/2011
2/6/2009
12/15/2010
2/6/2009
11/4/2011
12/1/2010
4/3/2009
5/1/2012
2/5/2010
11/6/2009
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/16/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/19/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/8/2013 None
N/A
1/3/2011 None
8/5/2011 None
N/A
N/A
ACTIVE
5/19/2011 None
N/A
TX
ACTIVE
3/18/2009 None
N/A
TEMPLE
TX
FORT WORTH TX
ACTIVE
ACTIVE
2/11/2011 None
2/25/2009 None
N/A
N/A
EDEN PRAIRIE MN
DALLAS
TX
ACTIVE
ACTIVE
11/17/2011 None
12/6/2010 None
N/A
N/A
HOUSTON
TX
ACTIVE
4/8/2009 None
N/A
TEMPLE
TX
ACTIVE
9/11/2008 None
N/A
PEDIATRIC SURGERY
(NEUROLOGY)
HOUSTON
TX
ACTIVE
8/29/2011 None
N/A
ORTHOPEDIC
SURGERY
SD
ACTIVE
5/21/2012 None
N/A
5/3/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/5/2010 None
11/24/2009 None
N/A
N/A
OH
TX
SAN ANTONIO TX
1515
HOLCOMBE
GENERAL SURGERY BLVD
TX
SURGICAL
5/16/2016 ONCOLOGY
PEDIATRIC EMER MED
2/6/2014 (PEDS)
PEDIATRICS
GERIATRIC
MEDICINE (INTERNAL
12/15/2015 INTERNAL MEDICINE MED)
ANESTHESIOLOGY
DIAGNOSTIC
11/4/2016 RADIOLOGY
PULMONARY
CRITICAL CARE
EMERGENCY
8/29/2013 MEDICINE
NEUROLOGICAL
8/15/2016 SURGERY
5/15/2017 SURGERY
OBSTETRICS AND
5/1/2017 GYNECOLOGY
EMERGENCY
2/5/2015 MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
WEBSTER
RAPID CITY
EMERGENCY
MEDICINE
Page 35 of 300
PARIS
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
N7992
Physician Name
BONNET, DAVID MACNAUGHTAN,
MD
N4955
BOOK, SCOTT GEORGE, MD
2/5/2010
P6341
BOOSTROM, SARAH YORK, MD
5/1/2013
P0350
P0170
BOOTH, ADA LOUISE, MD
BOOTWALA, YASMIN I, MD
BOQUE-SANTIAGO, MIGUEL JUAN,
MD
N7607
10/29/2010
7/15/2011
7/1/2011
9/1/2010
N6822
BORGMAN, MATTHEW A, MD
N8488
N7226
BORNEMEIER, RENEE ADAMS, MD
BOSE, SUBHASH, MD
BOTTALICO, JOSEPH NICHOLAS,
DO
1/18/2011
8/2/2010
BOUAJRAM, RAMI, MD
BOULANGER, KRISTINE SERENA,
MD
6/4/2010
P1969
N6185
P7252
N4956
7/1/2010
2/1/2012
7/15/2013
2/5/2010
P3291
BOUYARDEN, MICHAEL, MD
BOWEN, REBECCA CATHERINE,
MD
H7918
BOWERS, HAL GREGORY JR, MD
1/2/2012
N9173
N7684
BOWMAN, THOMAS ANDREW, MD
BOYD, KENDRA NICHOLE, MD
4/1/2011
9/15/2010
P4931
BOZORGI, FARSHID, MD
N5585
BRACKETT, JULIENNE , MD
4/9/2010
P7076
BRADWAY, JAMES ARTHUR II, MD
7/1/2013
6/1/2012
11/30/2012
Secondary Specialty
(Self-Designated)
DIAGNOSTIC
2/5/2015 RADIOLOGY
COLON AND RECTAL
5/1/2018 SURGERY
7/1/2016 UROLOGY
DALLAS
PEDIATRIC
CORPUS
FORENSIC MEDICINE CHRISTI
HOUSTON
PEDIATRIC INTENSIVE
7/1/2015 CARE
PEDIATRICS,
MATERNAL AND
OBSTETRICS
6/4/2015 NEPHROLOGY
Practice City
HOSPITALIST
CARDIOTHORACIC
ANESTHESIOLOGY
2/5/2015 INTERNAL MEDICINE NEPHROLOGY
OTORHINOLARYNGOL
6/1/2017 OGY
INTERVENTIONAL
DIAGNOSTIC
1/2/2017 RADIOLOGY
RADIOLOGY
NEONATALPERINATAL
4/1/2016 PEDIATRICS
MEDICINE
DIAGNOSTIC
PEDIATRIC
HEMATOLOGY/ONCOL
4/9/2015 OGY
Page 36 of 300
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
TX
ISSUED
TX
TX
FT. SAM
HOUSTON
TX
BALTIMORE
MD
ODESSA
TX
PLANO
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/29/2010 None
N/A
2/5/2010 None
N/A
5/1/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/20/2011 None
7/6/2011 None
N/A
N/A
9/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
7/27/2010 None
N/A
1/18/2011 None
8/23/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
2/10/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/22/2013 None
N/A
2/5/2010 None
N/A
SAN ANTONIO TX
ACTIVE
6/7/2012 None
N/A
PRESCOTT
AZ
ACTIVE
1/4/2012 None
N/A
LUBBOCK
HOUSTON
TX
TX
ACTIVE
ACTIVE
5/2/2011 None
9/20/2010 None
N/A
N/A
LOS ANGELES CA
ACTIVE
1/7/2013 None
N/A
HOUSTON
ACTIVE
4/20/2010 None
N/A
ACTIVE
7/8/2013 None
N/A
TX
License
Number
N6186
Physician Name
BRADY, JESSICA , MD
dicaid
dicaid
Agreement
End Date
Designated)
6/4/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/4/2010 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
3/22/2011 None
6/8/2009 None
6/18/2013 None
N/A
N/A
N/A
ACTIVE
4/21/2011 None
N/A
ACTIVE
8/7/2013 None
N/A
N6187
BRADY, KENNETH MARTIN, MD
6/4/2010
N6188
BRAHMA, ANURADHA , MD
6/4/2010
N9026
N2962
P6787
BRAKOVEC, JENNY LEE, MD
BRANDON, KIRRA LINDSAY, MD
BRANT, SARAH MARGARET, MD
3/15/2011
5/29/2009
6/3/2013
N9435
BRANTLY, ELISA KATHLEEN, MD
4/15/2011
P7077
BRAR, ANUREET KAUR, DO
P1274
BRAR, INDERJEET S, MD
P0171
BRATVOLD, JARED MICHAEL, MD
7/1/2011
N7231
BRAUN, AARON GREGORY, DO
8/2/2010
EMERGENCY
8/2/2015 MEDICINE
N4958
BRAZA, MARIEJANE MALINAO, MD
2/5/2010
N9816
BREDY, BRUNEL, MD
6/3/2011
KERRVILLE
TX
ACTIVE
TM00470 BREGER, ROBERT KARL, MD
9/1/2011
MILWAUKEE
WI
ACTIVE
10/11/2011 None
N/A
P1729
BRENDEL, WILLIAM BRIAN JR, MD
1/2/2012
9/1/2016 RADIOLOGY
PHYSICAL MED. &
ACTIVE
2/21/2012 None
N/A
P3511
BRENNAN, RACHEL MICHELLE, DO
6/8/2012
TX
ACTIVE
6/15/2012 None
N/A
N9817
P1525
BRENNEN, DAVID MICHAEL, MD
BRENNER, JOHN RUSSELL, DO
ACTIVE
ACTIVE
6/14/2011 None
12/13/2011 None
N/A
N/A
P0172
BREWER, BRYAN DANIEL, MD
SAN ANTONIO TX
SAN ANTONIO TX
FLOWER
MOUND
TX
ACTIVE
7/7/2011 None
N/A
G4225
BRICKER, JOHN TIMOTHY, MD
BRIGGER, KRISTIN ROGGENKAMP,
MD
HOUSTON
ACTIVE
11/22/2011 None
N/A
ACTIVE
4/27/2010 None
N/A
N5591
7/1/2013
11/4/2011
6/3/2011
12/1/2011
7/1/2011
11/15/2011
4/9/2010
6/4/2015
PEDIATRIC CRITICAL
CARE MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
OBSTETRICS AND
4/15/2016 UROLOGY
PHYSICAL MED. &
PULMONARY
CRITICAL CARE
11/4/2016 MEDICINE
6/8/2017 PEDIATRICS
PEDIATRICS,
6/3/2016 CARDIOLOGY
TEMPLE
HOUSTON
DALLAS
TX
TX
TX
UROLOGIC SURGERY
MASSILLON
OH
ACTIVE
11/28/2011 None
N/A
LUBBOCK
TX
ACTIVE
7/11/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
9/1/2010 None
N/A
DALLAS
PEDIATRICS
PEDIATRICS,
OBSTETRICS AND
4/9/2015 GYNECOLOGY
Page 37 of 300
TX
2/5/2010 None
UNDER
BOARD
6/13/2011 ORDER
N/A
6/3/2011
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N9436
BRINKER, STEPHANIE KAYE, MD
4/15/2011
N9680
BRINTON, MILTON HARVEY, MD
5/16/2011
P2202
BRITO, VERONICA DE CASTRO
FRANCISCO ESTEVAM DE, MD
3/1/2012
N9356
BRITO-DELLAN, NORMAN, MD
4/8/2011
P5938
BRITZ, GAVIN WAYNE, MD
4/1/2013
N4311
BROCK, ERIC RANDALL, MD
11/6/2009
11/6/2014 ORTHOPEDICS
N0661
BROCKER, JASON ANTHONY, MD
8/29/2008
N9818
BRODSKY, HARRIS ELLIOT, MD
6/3/2011
P0895
BRONICKI, RONALD ALAN, MD
9/1/2011
PEDIATRIC CRITICAL
9/1/2016 CARE MEDICINE
N6191
BROOKS, DAIN B, MD
6/4/2010
P0960
N6827
BROOKS, DAVID BRADLEY, MD
BROOKS, JACEL CRAIG, MD
9/15/2011
7/1/2010
PEDIATRIC
7/1/2015 PEDIATRICS
P7746
BROOKS, JOHN A, MD
8/30/2013
N8379
P6146
P6346
BROOKS, STEVEN EDWARD, MD
BROUSSARD, JOHNECA
ROCHELLE, DO
BROWN, AARON , DO
N1563
BROWN, AARON REED, MD
N6192
BROWN, ANTHONY LAMARR, MD
P4851
P6788
BROWN, BENJAMIN JOHN, DO
BROWN, BENTON LEE, MD
P1970
BROWN, BRIAN DOYLE, MD
1/3/2011
4/12/2013
5/1/2013
12/12/2008
6/4/2010
11/15/2012
6/3/2013
2/1/2012
Secondary Specialty
(Self-Designated)
Practice City
ADMINISTRATIVE
5/16/2016 VASCULAR SURGERY MEDICINE
PULMONARY
CRITICAL CARE
3/1/2017 MEDICINE
SLEEP MEDICINE
PALLIATIVE
MEDICINE
NEUROLOGICAL
4/1/2018 SURGERY
5/1/2018 PSYCHIATRY
EMERGENCY
12/12/2013 MEDICINE
EMERGENCY
11/15/2017 MEDICINE
N/A
5/19/2011 None
N/A
MINEOLA
NY
ACTIVE
3/8/2012 None
N/A
HOUSTON
TX
ACTIVE
4/18/2011 None
N/A
HOUSTON
MINERAL
WELLS
TX
ACTIVE
4/4/2013 None
N/A
TX
ACTIVE
11/13/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
9/11/2008 None
N/A
6/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
9/8/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/21/2011 None
7/19/2010 None
N/A
N/A
8/30/2013 None
N/A
EL PASO
CYPRESS
TX
TX
TX
LUBBOCK
TX
ACTIVE
1/6/2011 None
N/A
FT. WORTH
TX
ACTIVE
ACTIVE
4/16/2013 None
5/7/2013 None
N/A
N/A
PEARLAND
TX
ACTIVE
LICENSE
ISSUED
12/30/2008 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
11/26/2012 None
6/5/2013 None
N/A
N/A
ACTIVE
2/3/2012 None
N/A
SAN ANGELO
Page 38 of 300
4/15/2011 None
ACTIVE
URGENT CARE
MEDICINE
EMERGENCY
MEDICINE
Disciplinary
Status Date
TX
HOUSTON
TRAUMATIC
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
SPRING
GENERAL PRACTICE TEMPLE
PSYCHIATRY
SPORTS MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
12/17/2017 VITREOUS SURGERY
P5039
BROWN, C CHRISTOPHER, MD
P5039
P5039
N8380
BROWN, CHRISTOPHER JAMES,
MD
N7527
BROWN, DAWN KAMILAH, MD
P1971
P3292
BROWN, ELIZABETH J, MD
BROWN, EMILY RENEE, MD
N7993
BROWN, ERIC MICHAEL, MD
N0665
N8490
BROWN, JACOB WAYNE, MD
BROWN, JARROD MICHAEL, MD
8/29/2008
1/18/2011
N8768
BROWN, NICHOLAS MICHAEL, MD
2/15/2011
N5595
BROWN, PAUL DAVID, MD
1/3/2011
8/27/2010
2/1/2012
6/1/2012
10/29/2010
4/9/2010
P6347
P2961
BROWN, ROBERT ALLEN JR, DO
BROWN, SHANNA JEAN, MD
N1566
BROWNE, CATHERINE P., DO
N9520
P1168
BROWNE, LORNA , MD
BROWNE-BARNUM, MICHELLE L,
MD
BROWNING, ADRIANNE CONES,
MD
BROWNING, CAROL ANN
TENNENT, MD
10/17/2011
N2964
BROWN-VARGAS, DAMARIS, DO
5/29/2009
P2203
BROZENA, KRISTIN , MD
P1054
N4964
5/1/2013
5/1/2012
12/12/2008
5/2/2011
10/3/2011
2/5/2010
3/1/2012
CHILD AND
ADOLESCENT
PEDIATRIC
2/1/2017 NEPHROLOGY
6/1/2017 PEDIATRICS
EMERGENCY
10/29/2015 MEDICINE
EMERGENCY
8/29/2013 MEDICINE
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICAL SERVICES
OBSTETRICS
5/2/2016 RADIOLOGY
EMERGENCY
MEDICINE
Page 39 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
SAN ANTONIO TX
ACTIVE
12/20/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/20/2012 None
N/A
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
12/20/2012 None
N/A
1/3/2011 None
N/A
ACTIVE
9/1/2010 None
N/A
PSYCHIATRY
RADIATION
4/9/2015 ONCOLOGY
EMERGENCY
5/1/2018 MEDICINE
OBSTETRICS AND
OBSTETRICS AND
2/5/2015 GYNECOLOGY
DIAGNOSTIC
EMERGENCY
5/29/2014 MEDICINE
OBSTETRICS AND
3/1/2017 GYNECOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
DALLAS
SAINT LOUIS
TX
MO
ACTIVE
ACTIVE
2/7/2012 None
6/8/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
11/3/2010 None
N/A
TEMPLE
DALLAS
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
9/16/2008 None
1/25/2011 None
N/A
N/A
2/15/2011 None
N/A
ROCHESTER
MN
ACTIVE
4/28/2010 None
N/A
FT. HOOD
LUBBOCK
TX
TX
ACTIVE
ACTIVE
5/3/2013 None
5/3/2012 None
N/A
N/A
CONROE
6621 FANNIN
ST
TX
ACTIVE
1/5/2009 None
N/A
TX
ACTIVE
5/18/2011 None
N/A
ACTIVE
LICENSE
ISSUED
10/11/2011 None
N/A
2/5/2010 None
N/A
EDEN PRAIRIE MN
ACTIVE
12/16/2011 None
N/A
DALLAS
TX
ACTIVE
6/5/2009 None
N/A
SAN ANTONIO TX
ACTIVE
3/8/2012 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
MATERNAL AND
5/29/2009
12/12/2008
12/12/2013 MEDICAL GENETICS
N2965
N1567
BRUNER, JOSEPH PAUL, MD
BRUNETTI-PIERRI, NICOLA , MD
P5159
P2419
BRUNNER, NOEMI , MD
BRUNO, KATIE ELIZABETH, MD
N6196
BRYANT, JAMES DUKE, DO
6/4/2010
H7932
BUBOLZ, BETH , MD
2/5/2010
N8769
BUCA, STEFAN COSMIN, MD
N4965
BUCHANAN, BRYAN , MD
1/4/2013
3/15/2012
2/15/2011
2/5/2010
P0896
BUCHANAN, EDWARD PATRICK,
MD
N2967
P7255
BUCHANAN, ROBERT JOSEPH, MD
BUENDIA, JORGE , MD
N6197
BUENO HUME, CELYNE, MD
N4315
N7061
BUFFA, PETER MICHAEL SR, MD
BUI, BAO QUOC, MD
11/6/2009
7/15/2010
P7613
BUI, CINDY-THANHHOA HUYNH,
MD
8/15/2013
P6147
BUI, THERESA DIEM-HANG, DO
4/12/2013
N2970
P0817
P2963
BULLOCK, NICOLE CHRISTINE , DO
BUNCH, DARRELL ALAN, DO
BUNKER, SCOTT RYAN, DO
BURDICK, CHRISTOPHER JOSEPH,
MD
5/29/2009
8/26/2011
5/1/2012
P7081
P3609
BURGBACHER, TODD EUGENE, DO
9/1/2011
5/29/2009
7/15/2013
6/4/2010
7/1/2013
6/15/2012
1/4/2018 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
ODESSA
HOUSTON
EMERGENCY/TRAUM
A RADIOLOGY
EL PASO
Registration
Status of
Practice
Texas
State
License
TX
TX
ACTIVE
ACTIVE
TX
PEDIATRICS,
2/5/2015 CARDIOLOGY
EMERGENCY
2/15/2016 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
PEDIATRIC EMER
MED (PEDS)
PLASTIC &
RECONSTRUCTIVE
SURGERY
CRANIOFACIAL
9/1/2016 SURGERY
NEUROLOGICAL
5/29/2014 SURGERY
HEMATOLOGY/ONCOL
6/4/2015 OGY
INTERNAL MEDICINE
EMERGENCY
MEDICINE
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
CRITICAL CARE
EMERGENCY
6/15/2017 MEDICINE
LOS ANGELES CA
Page 40 of 300
Disciplinary
Status Date
6/3/2009 None
12/17/2008 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
1/10/2013 None
3/29/2012 None
N/A
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
2/15/2011 None
N/A
2/5/2010 None
N/A
HOUSTON
TX
ACTIVE
9/15/2011 None
N/A
TEMPLE
ODESSA
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
6/4/2009 None
7/22/2013 None
N/A
N/A
6/4/2010 None
N/A
11/17/2009 None
7/22/2010 None
N/A
N/A
MEXIA
AMARILLO
TX
TX
ACTIVE
ACTIVE
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
8/20/2013 None
N/A
4/12/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/12/2009 None
9/1/2011 None
5/3/2012 None
N/A
N/A
N/A
7/1/2013 None
N/A
6/15/2012 None
N/A
MANSFIELD
EMERGENCY
MEDICAL SERVICES
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
OBSTETRICS AND
2/5/2010
2/5/2015 SURGERY
GYNECOLOGY
N4967
BURGE, TOVA LYNN, MD
N4968
BURGER, CRAIG M, MD
2/5/2010
2/5/2015 PEDIATRICS
N6199
BURGOS, JOSE DAVID, MD
6/4/2010
N7234
BURGUENO, JORGE ENRIQUE, MD
8/2/2010
P0962
P5602
BURK, KATHRYN JEAN, MD
BURKART, RYAN DANIEL, MD
N9521
N7062
BURKETT, DANIELLE, DO
BURKHOLDER, HENRY LEROY IV,
MD
7/15/2010
P7614
BURLINGAME, ONAME ORO, MD
8/15/2013
EMERGENCY
9/15/2016 MEDICINE
OBSTETRICS AND
5/2/2016 GYNECOLOGY
PEDIATRICS,
ANATOMIC/CLINICAL
8/15/2018 PATHOLOGY
EMERGENCY
11/30/2017 MEDICINE
PAIN
MANAGEMENT/REHAB
6/4/2015 MED
OBSTETRICS AND
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
4/3/2014 MEDICINE
PEDIATRIC CRITICAL
9/15/2011
3/1/2013
5/2/2011
P4935
BURNETT, BRETT ALLEN, MD
11/30/2012
N6200
P4634
BURNETTE, CANDICE A, MD
BURNEY, JOHN MARCEL JAMES,
MD
10/15/2012
N3523
BURNS, KRISTINA PHYLLIS , MD
8/21/2009
N2425
BURNS, PAUL AARON, MD
L0910
BURNS, TANIA DENISE, MD
11/15/2011
N2017
BURRI, MANJULA VANI, MD
2/6/2009
P3293
P0177
BURRIS, GARRETT C, MD
BURROW, TREY CULLEN, MD
6/1/2012
7/1/2011
P0014
BURT, SELINA ANDREA, DO
N5598
BURTON, AIYANNA, MD
6/4/2010
4/3/2009
6/15/2011
4/9/2010
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HOSPITALIST
PEDIATRIC
6/1/2017 NEUROLOGY
MATERNAL AND
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
INTERNAL MEDICINE LUBBOCK
TX
ACTIVE
8/20/2010 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
10/31/2011 None
3/4/2013 None
N/A
N/A
MAYWOOD
IL
ACTIVE
LICENSE
ISSUED
5/24/2011 None
N/A
7/15/2010 None
N/A
BRENTWOOD TN
ACTIVE
8/26/2013 None
N/A
TEMPLE
ACTIVE
12/11/2012 None
N/A
6/4/2010 None
N/A
EMERGENCY
MEDICINE
TX
LICENSE
ISSUED
LONGVIEW
PEDIATRICS
PEDIATRICS
OBSTETRICS
Page 41 of 300
TX
ACTIVE
10/19/2012 None
N/A
SAN MARCOS TX
ACTIVE
9/1/2009 None
N/A
TEMPLE
TX
ACTIVE
4/20/2009 None
N/A
EL PASO
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
12/6/2011 None
N/A
5/7/2009 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/15/2012 None
8/25/2011 None
N/A
N/A
6/15/2011 None
N/A
ACTIVE
4/14/2010 None
N/A
HOUSTON
HOUSTON
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
8/16/2010
8/16/2015 ENDOCRINOLOGY
PEDIATRICS
8/21/2009
8/21/2014 NEUROLOGY
N7403
N3524
BURTON, AMY MATHEW, MD
BURTON, ERIK VON, MD
N6202
N1568
BURTON, MICHAEL ELLIOT, MD
BURTON, RUSSELL KEITH, MD
N6203
BUSCH, ROBERT JOHN, MD
6/4/2010
P5160
BUSKEN, CHRISTOPHER JOHN, MD
1/4/2013
P5604
BUSKEN, MELISSA ROSA, MD
3/1/2013
P2964
BUSTOS MUNOZ, SERGIO , MD
5/1/2012
P7402
BUTCHKO, GARY JON, MD
8/1/2013
EMERGENCY
3/1/2018 MEDICINE
PEDIATRIC CRITICAL
5/1/2017 PEDIATRICS
CARE MEDICINE
PEDIATRICS,
8/1/2018 CARDIOLOGY
PEDIATRICS
N6204
BUTLER WEBB, REBECCA, MD
6/4/2010
6/4/2015 PEDIATRICS
N0670
P5342
BUTLER, GORDON MARION III, MD
BUTLER, MICHELLE RENEE, MD
6/4/2010
12/12/2008
8/29/2008
2/1/2013
ORAL &
MAXILLOFACIAL
6/4/2015 SURGERY
8/29/2013 RADIOLOGY
N3527
N8492
BUTT, SANOBER, MD
BYBEE, KRISTY RUTHANN, DO
8/21/2009
1/18/2011
P0352
BYNON, JOHN STEVENSON JR, MD
7/15/2011
TRANSPLANT
7/15/2016 SURGERY
P0015
BYRD, MICHAEL CHARLES, MD
6/15/2011
P4936
N9357
BYRD, TERESA T, MD
BYRD, TIMOTHY MICHAEL, MD
11/30/2012
4/8/2011
OBSTETRICS AND
N7908
BYREDDY, ANITHA, MD
10/15/2010
P6349
BYUN, YOUNG SUP, MD
5/1/2013
N4317
CABALLERO, JOSHUA DAVID, MD
11/6/2009
PULMONARY
CRITICAL CARE
MEDICINE
HOSPITALIST
Practice City
Registration
Status of
Practice
Texas
State
License
DALLAS
DALLAS
TX
TX
ARLINGTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
FORT SAM
HOUSTON
TX
LICENSE
ISSUED
LICENSE
ISSUED
TX
AMARILLO
CORPUS
CHRISTI
Disciplinary
Status Date
8/24/2010 None
9/2/2009 None
N/A
N/A
6/4/2010 None
1/30/2009 None
N/A
N/A
6/4/2010 None
N/A
1/4/2013 None
N/A
ACTIVE
3/5/2013 None
N/A
TX
ACTIVE
5/8/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/5/2013 None
N/A
6/4/2010 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
9/12/2008 None
2/5/2013 None
N/A
N/A
TEMPLE
TX
ACTIVE
ACTIVE
12/30/2009 None
1/21/2011 None
N/A
N/A
7/21/2011 None
N/A
6/15/2011 None
N/A
11/30/2012 None
4/14/2011 None
N/A
N/A
10/15/2010 None
N/A
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
TEMPLE
TX
INTERNAL MEDICINE
EMERGENCY
11/6/2014 MEDICINE
Page 42 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
FORT WORTH TX
ACTIVE
5/9/2013 None
N/A
TEMPLE
ACTIVE
1/6/2010 None
N/A
TX
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
EMERGENCY
P1056
CABANAS, JOSE GUILLERMO, MD
10/3/2011
10/3/2016 MEDICINE
MEDICAL SERVICES
P5605
CABILING, DAVID SHANNON, MD
3/1/2013
N3530
CABRA, OMAR HUMBERTO , MD
8/21/2009
PEDIATRICS,
N6205
CABRERA, ANTONIO GABRIEL, MD
6/4/2010
6/4/2015 PEDIATRICS
CARDIOLOGY
CACERES LARA, ALFREDO BORIS,
P2602
MD
4/2/2012
EMERGENCY
EMERGENCY
N7909
CAFFREY, THOMAS ARTHUR, MD
10/15/2010
10/15/2015 MEDICINE
MEDICINE
CAGA-ANAN, MARIA CRISTINA
P7403
ESPERA, MD
8/1/2013
CAHUAYME-ZUNIGA, LIZBETH
INFECTIOUS
P0016
JANICE, MD
6/15/2011
6/15/2016 DISEASES
INTERNAL MEDICINE
EMERGENCY
P4635
CAIRE, SAMUEL RAHN, MD
10/15/2012
10/15/2017 MEDICINE
CAIRO LAVADO, JAVIER BENITO,
INFECTIOUS
N2427
MD
4/3/2009
4/3/2014 DISEASES
INTERNAL MEDICINE
HEMATOLOGY P0178
CAIRO, MICHELINA MARIE, MD
7/1/2011
7/1/2016 ONCOLOGY
INTERNAL MEDICINE
P2422
CAJITA, CEZAR LAGO, MD
3/15/2012
P5606
P6594
CAJITA, ELEONOR IGNACIO, MD
CALA MORALES, CLAUDIA LUCIA,
MD
5/15/2013
N8892
CALABRO, JAMES ANTHONY, MD
3/1/2011
N7235
P0354
CALDERIN, JULIO ANGEL, MD
CALDERON, ANA MARIA, MD
P0557
CALERO, SHANNA MICHELLE, MD
N1274
N4320
P2423
N5601
P7404
3/1/2013
AUSTIN
HOUSTON
TX
TX
SAN ANTONIO TX
8/1/2011
8/1/2016
CALHOUN, WILLIAM JAMES, MD
10/10/2008
10/10/2013
CALI, REBECCA LAMAR, MD
CALLEROS MACIAS, JESUS
EDMUNDO , MD
CALLEY, DOYLE, MD
CALLOWAY, TRACIE SHENELLE,
DO
11/6/2009
11/6/2014
3/15/2012
4/9/2010
3/15/2017
4/9/2015
10/12/2011 None
3/13/2013 None
9/21/2009 None
N/A
N/A
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/6/2012 None
N/A
10/15/2010 None
N/A
8/12/2013 None
N/A
6/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
10/19/2012 None
N/A
HOUSTON
TX
ACTIVE
4/8/2009 None
N/A
HOUSTON
HARLINGEN
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
7/7/2011 None
3/19/2012 None
N/A
N/A
3/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
6/18/2013 None
N/A
3/1/2011 None
N/A
TX
ACTIVE
ACTIVE
8/5/2010 None
8/24/2011 None
N/A
N/A
TX
ACTIVE
8/15/2011 None
N/A
TX
ACTIVE
10/29/2008 None
N/A
MD
ACTIVE
2/5/2010 None
N/A
TX
MI
ACTIVE
ACTIVE
LICENSE
ISSUED
3/23/2012 None
4/27/2010 None
N/A
N/A
8/1/2013 None
N/A
TEXARKANA
Page 43 of 300
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
SULPHUR
VASCULAR SURGERY GENERAL SURGERY SPRINGS
INTERNAL MEDICINE
EMERGENCY
MEDICINE
EL PASO
ALLERGY AND
PULMONARY
IMMUNOLOGY
DISEASES
GALVESTON
COLON AND RECTAL
SURGERY
TANEYTOWN
DIAGNOSTIC
INTERVENTIONAL
RADIOLOGY
RADIOLOGY
EL PASO
INTERNAL MEDICINE
FREMONT
8/1/2018 PEDIATRICS
Disciplinary
Status Date
OK
EMERGENCY
3/1/2016 MEDICINE
8/2/2015
7/15/2016
Registration
Status Date
Disciplinary
Status of
Texas
License
OKLAHOMA
CITY
3/1/2018 PEDIATRICS
8/2/2010
7/15/2011
8/1/2013
Practice City
Registration
Status of
Practice
Texas
State
License
TX
License
Number
P3297
Physician Name
P2206
N7784
CAMACHO, ALLAN CASTILLO, MD
CAMARILLO, RANDAL MATTHEW,
MD
CAMCIOGLU, BELGIN, MD
N5602
CAMERON, DAVID GLEN III, DO
dicaid
dicaid
Agreement
End Date
Designated)
6/1/2012
3/1/2012
10/1/2010
4/9/2010
ACTIVE
ACTIVE
LICENSE
ISSUED
UROLOGIC
UROLOGIC SURGERY ONCOLOGY
PLASTIC &
RECONSTRUCTIVE
SURGERY
PLASTIC SURGERY
PEDIATRICS
PEDIATRICS
HEMATOLOGY/ONCOL
OGY
INTERNAL MEDICINE
EMERGENCY
MEDICINE
ANESTHESIOLOGY ANESTHESIOLOGY
PAIN MANAGEMENT
INFECTIOUS
DISEASES
INTERNAL MEDICINE
FAMILY MEDICINE
FAMILY PRACTICE
EMERGENCY
MEDICINE
CAMMACK, JAMES THOMAS, MD
7/15/2010
7/15/2015
P1169
N7063
F6502
10/17/2011
7/15/2010
2/6/2009
10/17/2016
7/15/2015
2/6/2014
P6595
CAMP, STEVEN MARTIN, MD
CAMPANINI, EMIR RAFAEL, MD
CAMPBELL, LYNN RENEE, MD
CAMPBELL, MATTHEW THOMAS,
MD
5/15/2013
5/15/2018
N7686
CAMPBELL, MITRA MARGARET, DO
9/15/2010
9/15/2015
P2833
4/13/2012
4/13/2017
4/1/2013
1/3/2011
4/1/2018
1/3/2016
P3514
CAMPBELL, NEVILLE FITZROY, MD
CAMPO MALDONADO, JOSE
ERNESTO, MD
CAMPOS, REBECCA LEE, MD
CAMP-ROGERS, TERESA
RANDELLE, MD
6/8/2012
6/8/2017
P1732
CANACCI, ANASTASIA MARIE, MD
1/2/2012
P4739
N2021
11/1/2012
2/6/2009
P0706
CANNON, BRETT H, MD
CANNON, DEAN M., MD
CANOVA CIPRIANO, EDUARDO
CARLOS, MD
N2977
N0675
CANTOR, MICHAEL DAN, DO
CANTU, ERNESTO JR, MD
5/29/2009
8/29/2008
P7083
CANTU, JAMES ARNOLD, MD
7/1/2013
N3532
P0707
CANTU, MARIBEL , MD
CANTU, SERGIO SAUL, MD
8/21/2009
8/15/2011
8/15/2011
Practice City
ORTHOPEDIC
3/1/2017 SURGERY
EMERGENCY
4/9/2015 MEDICINE
H5696
P5940
N8383
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/1/2012 None
N/A
4/2/2012 None
10/25/2010 None
N/A
N/A
TX
ACTIVE
4/9/2010 None
UNDER
BOARD
7/26/2010 ORDER
FORT WORTH TX
SAN ANGELO TX
AUSTIN
TX
ACTIVE
ACTIVE
ACTIVE
11/1/2011 None
7/26/2010 None
2/11/2009 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
5/22/2013 None
N/A
KILLEEN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
10/21/2010 None
N/A
4/13/2012 None
N/A
4/1/2013 None
1/11/2011 None
N/A
N/A
6/8/2012 None
N/A
2/24/2012 None
N/A
11/1/2012 None
2/16/2009 None
N/A
N/A
LUBBOCK
SAN ANTONIO TX
N/A
7/1/2010
1/2/2017 PATHOLOGY
EMERGENCY
11/1/2017 MEDICINE
2/6/2014 PEDIATRICS
CARROLLTON TX
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
INTERVENTIONAL
LAREDO
TX
ACTIVE
8/18/2011 None
N/A
TEXARKANA
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
6/15/2009 None
9/30/2008 None
N/A
N/A
KINGSVILLE
TX
BROWNSVILL
E
TX
ACTIVE
7/8/2013 None
N/A
ACTIVE
ACTIVE
8/26/2009 None
8/19/2011 None
N/A
N/A
CARDIOLOGY
EMERGENCY
MEDICINE
HOSPITALIST
Page 44 of 300
License
Number
Physician Name
N3533
CANTWELL, WILLIAM SCOTT , MD
N8081
CAO, CARLOS ERNESTO, MD
N8770
CAO, HIEP ANDREW, MD
N5604
P3515
CAPELLA, JEANNETTE MARIE, MD
CAPERTON, KIMBERLY KRISTA,
MD
N9823
N3536
P2604
CAPERTON, ROBIN, MD
CAPT, WILLIAM MICHAEL, MD
CARABALLO, AIXA, MD
P5250
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
CRITICAL CARE
8/21/2009
INTERNAL MEDICINE TYLER
11/15/2010
2/15/2011
4/9/2010
6/8/2012
1/4/2013
1/3/2011
4/13/2012
N7236
CARBAJAL, JOSE MARCOS, MD
CARBALLO, JUAN EDUARDO, MD
CARDENAS GOMEZ, EDGAR IVAN,
MD
P0179
N3537
CARDENAS, RAUL JOSE, MD
CARDO-HUNTER, ALICE , DO
7/1/2011
8/21/2009
N8384
P2834
8/2/2010
8/1/2016 NEPHROLOGY
EMERGENCY
1/3/2016 MEDICINE
1/4/2013
EMERGENCY
1/4/2018 MEDICINE
8/16/2010
P5161
CARDON, CANDICE THERESA, MD
N7404
CARGILE, CHRIS SCOTT, MD
N8894
CARGILE, JOHN CORDELL, MD
3/1/2011
N7608
CARLOCK, JOSEPH BENJAMIN, MD
9/1/2010
N7237
P7615
CARLSON, TODD EVAN, MD
CARMEL, MAUDE, MD
N6832
CARNELL, JENNIFER, MD
8/2/2010
8/15/2013
7/1/2010
N/A
2/13/2011 None
N/A
2/15/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/27/2012 None
N/A
6/3/2011 None
10/8/2009 None
4/9/2012 None
N/A
N/A
N/A
1/16/2013 None
N/A
8/1/2011 None
N/A
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
1/3/2011 None
4/16/2012 None
N/A
N/A
MONAHANS
TX
ACTIVE
9/3/2010 None
N/A
HOUSTON
MCALLEN
TX
TX
ACTIVE
ACTIVE
7/8/2011 None
8/27/2009 None
N/A
N/A
CORPUS
CHRISTI
TX
ACTIVE
LICENSE
ISSUED
1/24/2013 None
N/A
8/16/2010 None
N/A
PHYSICAL MED. &
EMERGENCY
8/2/2015 MEDICINE
8/15/2018 UROLOGY
EMERGENCY
7/1/2015 MEDICINE
ACTIVE
3/18/2011 None
N/A
ACTIVE
11/1/2010 None
N/A
CO
RADIOLOGY
LUBBOCK
AUSTIN
TX
TX
CARDIOLOGY
HOUSTON
TX
INTERNAL MEDICINE
NEUROLOGICAL
7/1/2016 SURGERY
SPINE MEDICINE
PEDIATRIC
EMERGENCY
MEDICINE (EM)
PSYCHIATRY
SPINAL CORD
INJURY MEDICINE
Page 45 of 300
Disciplinary
Status Date
8/31/2009 None
SURGICAL CRITICAL
OTORHINOLARYNGOL
6/8/2017 OGY
LAFAYETTE
CARABELLO, BLASE ANTHONY, MD
CARBAJAL MENDOZA, ROGER
FRANCISCO, MD
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
LICENSE
ISSUED
6/3/2016 PEDIATRICS
8/1/2011
TX
EMERGENCY
11/15/2015 MEDICINE
6/3/2011
8/21/2009
4/2/2012
P0559
Registration
Status of
Practice
Texas
State
License
TEMPLE
TX
RICHMOND
DALLAS
TX
TX
ACTIVE
ACTIVE
8/12/2010 None
8/20/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
7/12/2010 None
N/A
dicaid
dicaid
License
Agreement
Physician Name
Start Date
End Date
Designated)
UNDERSEA
HYPERBARIC MED
P1528
CARPENTER, SHAUN ROBERT, MD
12/1/2011
12/1/2016 (EMER MED)
N8496
CARPIO, BERNARDO , MD
1/18/2011
PALLIATIVE
MEDICINE
MATERNAL AND
FETAL MEDICINE
CARRASCO, ERIK, MD
N2979
P6953
P3127
CARRENO, CARLOS ALBERTO, MD
CARRERAS, YULY D, MD
CARRERO, ANGELA MARIA, MD
5/29/2009
6/14/2013
5/15/2012
N6834
N5608
P3516
P2606
P2103
CARRIKER, CURTIS G, MD
CARROLL, TRAVIS ROD, MD
CARROTHERS, IRENE A, MD
CARROUTH, DAVID AARON, MD
CARSON, WILLIAM KEITH, MD
7/1/2010
4/9/2010
6/8/2012
4/2/2012
2/10/2012
OBSTETRICS AND
EMERGENCY
7/1/2015 MEDICINE
4/9/2015 PEDIATRICS
2/10/2017 RADIOLOGY
N6208
6/4/2010
N8896
P3298
CARTER, AARON MICHAEL, MD
CARTER, DORNECHIA ELVERNA
GEORGE, MD
CARUSO, ANDREW C, MD
3/1/2011
6/1/2012
N7529
CARUSO, JOSEPH MICHAEL, MD
8/27/2010
N8624
CARUSO, LOUIS, MD
2/4/2011
P0560
CARVER, ALISSA RENEE, MD
8/1/2011
MATERNAL AND
P2608
CASALE, ANTHONY JOSEPH, MD
4/2/2012
4/2/2017 PEDIATRIC UROLOGY UROLOGY
P0017
P7618
N4978
CASSADY, CHARLES PATRICK, MD
P6954
N1576
P4636
6/14/2013
12/12/2008
10/15/2012
Practice City
COVINGTON
N4975
CASAL-FERNANDEZ, ALYN
CRISTINA, MD
CASANOVA, EDWARD , MD
CASAS, CHEYANNE MARIE, MD
CASIANO, ELIZABETH RAMIREZ,
MD
CASIANO, FELIX ANGEL JR, MD
2/5/2010
Secondary Specialty
(Self-Designated)
NEONATOLOGY
HOSPITALIST
TX
NY
LUBBOCK
DALLAS
ADDISON
HOUSTON
TX
TX
TX
TX
HOUSTON
2/5/2010
TX
TX
CARDIOLOGY
GALVESTON
PUBLIC
HEALTH/PREVENTIVE
6/14/2018 MEDICINE (GENERAL)
6/15/2016 UROGYNECOLOGY
LA
HOUSTON
BRONX
8/27/2015 VASCULAR SURGERY GENERAL SURGERY ARLINGTON
6/15/2011
8/15/2013
Registration
Status of
Practice
Texas
State
License
GYNECOLOGIC
SURGERY
12/8/2011 None
1/21/2011 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
6/3/2009 None
6/24/2013 None
6/14/2012 None
N/A
N/A
N/A
7/1/2010
4/15/2010
6/19/2012
4/4/2012
2/28/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
4/18/2011 None
6/14/2012 None
SEE
PREVIOUS
9/8/2010 ORDER
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
SAN ANTONIO TX
SAN ANTONIO TX
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
HOUSTON
TX
SHERMAN
Page 46 of 300
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
N/A
N/A
8/30/2010
2/4/2011 None
N/A
8/10/2011 None
N/A
4/2/2012 None
N/A
6/18/2013 None
12/18/2008 None
10/17/2012 None
N/A
N/A
N/A
6/20/2011 None
8/20/2013 None
N/A
N/A
2/5/2010 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1170
CASTANEDA, WILFRIDO
ROLANDO, MD
CASTANO DE ZAMACONA,
MARCELA LUCIA, MD
10/17/2011
P4852
P2836
N2980
CASTILLO, HEIDI, MD
CASTILLO, JUANITA, MD
CASTILLO, LETICIA, MD
11/15/2012
4/13/2012
5/29/2009
P3612
P3517
CASTILLO, MANUEL, MD
CASTRO-SILVA, FERNANDO
JAVIER, MD
H4886
CATER, GARY WAYNE, DO
P5046
CATTANO, DAVIDE , MD
12/17/2012
P5046
12/17/2012
P5046
12/17/2012
P7256
CAUTHEN, CLAY ADAMS, MD
CARDIOVASCULAR
7/15/2018 DISEASES
N9825
CAVANAUGH, MARK R, MD
N3542
8/21/2009
6/15/2012
6/8/2012
5/2/2011
7/15/2013
DEVELOPMENTALBEHAVIORAL
HEMATOLOGY
P0018
P3130
CAVANESS, KEITH MICHAEL, DO
CAYCE, RACHAEL LYNN, MD
6/15/2011
5/15/2012
SURGICAL
6/15/2016 ONCOLOGY
P5784
CAYO, ASHLEY KAPPES, MD
CEBALLOS, GILDARDO ANDRES,
MD
3/15/2013
7/15/2011
P0357
P6794
CEDRONE, ANTHONY JOSEPH, MD
N7995
P6955
P0964
N7065
CELIS, BROOKE BAKER, MD
CEPEDA-IRUEGAS, NIRU , MD
CERNA, NORMA CAROLINA, MD
CEVIK, CIHAN, MD
6/3/2011
DIAGNOSTIC
8/21/2014 RADIOLOGY
6/3/2013
10/29/2010
6/14/2013
9/15/2011
7/15/2010
PEDIATRICS
Practice City
Disciplinary
Status Date
9/10/2009 None
N/A
SAN ANTONIO TX
ACTIVE
10/20/2011 None
N/A
HOUSTON
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
11/21/2012 None
4/18/2012 None
6/19/2009 None
N/A
N/A
N/A
6/15/2012 None
N/A
TX
PATHOLOGY
DALLAS
TX
ACTIVE
6/18/2012 None
N/A
PEDIATRICS
CRITICAL CARE
ANESTHESIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
TALLAHASSEE FL
ACTIVE
5/11/2011 None
N/A
HOUSTON
TX
ACTIVE
12/20/2012 None
N/A
HOUSTON
TX
ACTIVE
12/20/2012 None
N/A
HOUSTON
TX
ACTIVE
12/20/2012 None
N/A
OTHER SPECIALTY
AUSTIN
TX
8/7/2013 None
N/A
HOUSTON
TX
6/3/2011 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/15/2011 None
6/12/2012 None
N/A
N/A
MILWAUKEE
WI
ACTIVE
3/29/2013 None
N/A
RICHMOND
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
7/20/2011 None
N/A
6/3/2013 None
N/A
SURGICAL
ONCOLOGY
INTERVENTIONAL
CARDIOLOGY
ANESTHESIOLOGY
INTERNAL MEDICINE
FAMILY MEDICINE
INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
TRANSPLANT
SURGERY
6/3/2018 CARDIOLOGY
10/29/2015
6/14/2018
9/15/2016
7/15/2015
Secondary Specialty
(Self-Designated)
ANGIOGRAPHY &
INTERVENTIONAL
RADIOLOGY
Registration
Status of
Practice
Texas
State
License
CARDIOLOGY
Page 47 of 300
GALVESTON
tx
SAN ANGELO
HOUSTON
TX
TX
10/29/2010
6/26/2013
9/19/2011
7/26/2010
None
None
None
None
N/A
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N7239
CHAHAL, MANISHA KAUR, MD
8/2/2010
P3299
CHAI, CHRISTY YOON-HEE, MD
6/1/2012
P5049
CHAICHA-BROM, TIRA, MD
12/17/2012
P5049
12/17/2012
P5049
12/17/2012
P6956
CHAISSON-MCRAE, CLARISSA, MD
P7409
P1171
CHAKILAM, SRUJANA, MD
CHAKKALAKAL, ANNETTE
ELIZABETH JAMES, MD
10/17/2011
M3976
CHAKMAKIAN, VACHE, MD
4/9/2010
N9437
CHAKRAVARTHY, MITHUN, MD
4/15/2011
P1060
CHALASANI, RAMBABU , MD
10/3/2011
P5785
P5943
CHALLA, SOUJANYA, MD
CHALLA, TEJO RAMAM, MD
3/15/2013
4/1/2013
N0685
CHAMARTHI, PHANI PRABHAKARA
SRINIVASA SASTRY, MD
CHAMBERS-KERSH, LAURA SINDA,
MD
CHAN VILLANUEVA, IMELDA
VALERA, MD
N4334
P2967
CHAN, RODNEY K, MD
CHAN, ROXANNE, MD
P4637
CHAN, SOI-YU, MD
P3518
P4429
6/14/2013
8/1/2013
6/8/2012
SURGICAL
6/1/2017 ONCOLOGY
ENDOCRINOLOGY,
DIABETES AND
12/17/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
ENDOCRINOLOGY,
DIABETES AND
Practice City
NEW YORK
NY
GENERAL SURGERY
CARDIOVASCULAR
8/1/2018 DISEASES
11/6/2009
5/1/2012
5/1/2017 RADIOLOGY
PEDIATRICS,
9/9/2010 None
N/A
6/1/2012 None
N/A
ACTIVE
12/18/2012 None
N/A
INTERNAL MEDICINE AUSTIN
TX
ACTIVE
12/18/2012 None
N/A
TX
ACTIVE
12/18/2012 None
N/A
SAN ANTONIO TX
ACTIVE
7/16/2013 None
N/A
INTERNAL MEDICINE FORT WORTH TX
ACTIVE
8/13/2013 None
N/A
CO
ACTIVE
11/21/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
4/26/2010 None
N/A
4/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
10/17/2011 None
N/A
3/15/2013 None
4/15/2013 None
N/A
N/A
6/8/2017 PEDIATRICS
8/29/2008
Disciplinary
Status Date
TX
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
DENVER
EMERGENCY
4/9/2015 MEDICINE
FAMILY PRACTICE
BORGER
CARDIOVASCULAR
4/15/2016 DISEASES
INTERNAL MEDICINE
GASTROENTEROLOG
10/3/2016 Y
HOUSTON
9/17/2012
10/15/2012
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
EL PASO
TX
ACTIVE
6/11/2012 None
N/A
FT HOOD
TX
MADISONVILL
E
TX
ACTIVE
10/9/2012 None
N/A
ACTIVE
10/10/2008 None
N/A
GENERAL SURGERY SAN ANTONIO TX
ATLANTA
GA
ACTIVE
ACTIVE
11/18/2009 None
5/3/2012 None
N/A
N/A
PEDIATRICS
ACTIVE
10/18/2012 None
N/A
OBSTETRICS
Page 48 of 300
TEMPLE
TX
License
Number
N2435
N5613
Physician Name
CHANDER, AJAY , MD
CHANDLER, JENNIFER STOKEY,
MD
dicaid
dicaid
Agreement
End Date
Designated)
4/3/2009
4/9/2010
EMERGENCY
4/9/2015 MEDICINE
5/15/2013
11/30/2012
PHYSICAL MED. &
CHANDRASENAN, SACHIN, MD
6/4/2010
N1278
P7749
P3613
CHANDRAVANKA, CHAITANYA
SRAVANTHI, MD
CHANG, ALEX CHIA, MD
CHANG, EDWARD, MD
10/10/2008
8/30/2013
6/15/2012
P3519
CHANG, MARY PEARL, MD
6/8/2012
P5344
CHANG, RHODA YUEH, MD
2/1/2013
P6353
P7620
CHANG, RICHARD RAY, MD
CHANG, TIFFANY, MD
5/1/2013
8/15/2013
P4741
CHANG, VICTOR, MD
11/1/2012
P0561
N8897
CHAO, STEPHEN KEN-WEI, MD
CHAPA, JUDITH , MD
8/1/2011
3/1/2011
N6214
CHAPIN, BRIAN FRANCIS, MD
CHAPLYNSKY, MARTA JOANNA,
MD
CHAPMAN, JOHN CAYLOS, MD
6/4/2010
6/4/2015 UROLOGY
2/4/2011
7/1/2011
2/4/2016 RADIOLOGY
8/1/2011
P1736
N4340
CHAR, VANDANA, MD
CHARFEN, CHARLOTTE NEWMAN,
MD
CHASEN, NOAH NATHAN, MD
1/2/2012
11/6/2009
P1281
N0689
N2027
CHATER, MICHAEL GEORGE, MD
CHAU, CHUONG JOHN, MD
CHAU, LIEU NGOC, DO
11/4/2011
8/29/2008
2/6/2009
P6596
P4939
CHANDLER, SETH DUNCAN, DO
CHANDLER, WEST, MD
N6212
N8628
P0182
P0562
Secondary Specialty
(Self-Designated)
CARDIOVASCULAR
DISEASES
Practice City
Registration
Status of
Practice
Texas
State
License
NE
ACTIVE
4/14/2009 None
N/A
LONGVIEW
TX
ACTIVE
4/16/2010 None
N/A
MARSHALL
TX
7/4/2013 None
12/24/2012 None
N/A
N/A
6/4/2010 None
N/A
1/8/2009 None
9/9/2013 None
6/20/2012 None
N/A
N/A
N/A
HOUSTON
ANGLETON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
6/25/2012 None
N/A
ACTIVE
2/4/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
6/12/2013 None
8/20/2013 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
12/13/2012 None
N/A
8/1/2011 None
3/4/2011 None
N/A
N/A
6/4/2010 None
N/A
2/4/2011 None
7/7/2011 None
N/A
N/A
8/1/2011 None
N/A
FL
ACTIVE
ACTIVE
1/16/2012 None
11/24/2009 None
N/A
N/A
HOUSTON
TX
WESLACO
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
11/15/2011 None
9/25/2008 None
3/9/2009 None
N/A
N/A
N/A
EMERGENCY
5/1/2018 MEDICINE
FT. WORTH
8/15/2018 NEUROLOGY
PHYSICAL MED. &
HOUSTON
MCALLEN
TX
UROLOGIC
ONCOLOGY
NEUROLOGY
8/1/2016 PEDIATRICS
EMERGENCY
1/2/2017 MEDICINE
11/6/2014 RADIOLOGY
OTORHINOLARYNGOL
11/4/2016 OGY
RHINOLOGY
Page 49 of 300
Disciplinary
Status Date
NORFOLK
OSTEO
MANIPULATIVE
MEDICINE
EMERGENCY
6/8/2017 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
KISSIMMEE
TX
License
Number
Physician Name
N5615
P1529
CHAUDHARI, ALOK MOHAN, MD
CHAUDHARY, AISHA LUBNA, MD
P1975
CHAUDHARY, HUMERA M, MD
P5051
P5051
P5051
CHAUDHARY, VISHY, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
NEUROLOGICAL
4/9/2010
4/9/2015 SURGERY
12/1/2011
DIAGNOSTIC
ABDOMINAL
2/1/2012
2/1/2017 RADIOLOGY
RADIOLOGY
Practice City
ZANESVILLE
OH
ACTIVE
ACTIVE
EL PASO
TX
YORK
YORK
PA
PA
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
12/17/2012
12/17/2012
12/17/2012
AM00023 CHAUDHRY, HAROON W, MD
10/1/2012
N0691
P3614
CHAUDHRY, IMTIAZ MANZOOR, MD
CHAUDHRY, PRIYANKA , MD
8/29/2008
6/15/2012
6/15/2017 NEUROLOGY
N9439
CHAUDHRY, SAMEER, MD
4/15/2011
P3132
CHAUDHRY, SARMAD MUNIR, MD
5/15/2012
P3133
CHAUDHRY, SUFIYAN HAFEEZ, MD
5/15/2012
PULMONARY
CRITICAL CARE
CRITICAL CARE
5/15/2017 MEDICINE
MEDICINE
DALLAS
GASTROENTEROLOG
5/15/2017 Y
INTERNAL MEDICINE MEMPHIS
P1530
P5162
N0692
CHAUDRY, KANWAL NISAR, MD
CHAUM, EDWARD, MD
CHAUVET, MARCELO, MD
12/1/2011
1/4/2013
8/29/2008
N8280
CHAVA, PRAVEEN, MD
N8497
N7067
P1977
P2211
CHAVA, SAMYUKTA, MD
CHAVAN, SUMEET NARESH, MD
CHAVDA, CHIRAG, MD
CHAVEZ MAC GREGOR, MARIANA ,
MD
N8629
CHAVEZ PAZ, JUAN MARCOS, MD
2/4/2011
N5617
CHAVEZ, ALMA ISELA, MD
4/9/2010
N6215
CHAVEZ-GELO, EDNA MELINA, MD
12/15/2010
1/18/2011
7/15/2010
2/1/2012
3/1/2012
6/4/2010
DALLAS
GERIATRIC MEDICINE
GASTROENTEROLOG
1/18/2016 Y
3/1/2017 ONCOLOGY
PULMONARY
CRITICAL CARE
2/4/2016 MEDICINE
PEDIATRIC
EMERGENCY
6/4/2015 MEDICINE
PEDIATRICS
Registration
Status of
Practice
Texas
State
License
MEMPHIS
EL PASO
N/A
N/A
2/3/2012 None
N/A
12/17/2012 None
1/17/2013 None
1/17/2013 None
N/A
N/A
N/A
ACTIVE
10/3/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/24/2008 None
6/19/2012 None
N/A
N/A
4/15/2011 None
N/A
TX
ACTIVE
6/15/2012 None
N/A
TN
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
5/31/2012 None
N/A
12/1/2011 None
1/10/2013 None
10/15/2008 None
N/A
N/A
N/A
12/15/2010 None
N/A
1/18/2011 None
7/19/2010 None
2/24/2012 None
N/A
N/A
N/A
3/28/2012 None
N/A
2/4/2011 None
N/A
4/26/2010 None
N/A
6/4/2010 None
N/A
TX
TX
TN
TX
INTERNAL MEDICINE
HOSPITALIST
SAN ANTONIO TX
TX
ACTIVE
LICENSE
ISSUED
URGENT CARE
MEDICINE
Page 50 of 300
EL PASO
Disciplinary
Status Date
4/28/2010 None
12/9/2011 None
FAMILY PRACTICE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
LICENSE
ISSUED
License
Number
P4941
Physician Name
P7087
N2028
CHAWLA, DAVE, MD
CHECKA, CRISTINA MARGARITA,
MD
CHEEMA, FAISAL NAWAZ, MD
P1282
CHEEMA, SIDRA SHAFIQ, MD
dicaid
dicaid
Agreement
End Date
Designated)
11/30/2012
7/1/2013
2/6/2009
11/4/2011
5/2/2011
ACTIVE
12/11/2012 None
N/A
BREAST ONCOLOGY NASSAU BAY
TX
TX
ACTIVE
ACTIVE
7/2/2013 None
2/16/2009 None
N/A
N/A
ACTIVE
11/10/2011 None
N/A
ACTIVE
5/11/2011 None
N/A
ADDICTION
6/4/2015 PSYCHIATRY
PSYCHIATRY
ACTIVE
LICENSE
ISSUED
9/30/2009 None
N/A
6/4/2010 None
N/A
1/2/2017 PEDIATRICS
PULMONARY
CRITICAL CARE
6/15/2016 MEDICINE
EMERGENCY
2/8/2018 MEDICINE
ACTIVE
1/23/2012 None
N/A
TX
ACTIVE
6/21/2011 None
N/A
TX
ACTIVE
2/18/2013 None
N/A
ACTIVE
4/9/2012 None
N/A
N3551
CHEEMA, ZULFIQAR FAISAL , MD
8/21/2009
N6216
6/4/2010
P1737
CHELEBIAN, JACK, MD
CHELIKANI KOTAGIRI, SUNANDA,
MD
P0021
CHELIKANI, MURALIKRISHNA
VENKATANARASIMHA, MD
P5522
CHEN, AARON, MD
2/8/2013
P2613
CHEN, CAROLYN , MD
4/2/2012
P1738
CHEN, DONGNING, MD
1/2/2012
N2438
CHEN, JEFFREY , MD
4/3/2009
P7412
CHEN, JERRY, DO
8/1/2013
P2213
P0022
N1582
CHEN, JOYCE CHI-YI, MD
CHEN, KAREN, MD
CHEN, KENNETH, MD
P1061
CHEN, MERRY, MD
10/3/2011
10/3/2016 NEUROLOGY
N8171
CHEN, MING, MD
12/1/2010
N6219
CHEN, NANCY , MD
3/1/2012
6/15/2011
12/12/2008
6/4/2010
Disciplinary
Status Date
TX
SURGICAL
7/1/2018 ONCOLOGY
2/6/2014 GERIATRICS
ANATOMIC/CLINICAL
11/4/2016 PATHOLOGY
CHEEMA, YASIR IMTIAZ, MD
6/15/2011
Registration
Status Date
Disciplinary
Status of
Texas
License
Practice City
MARBLE
FALLS
N9527
1/2/2012
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
RADIATION
4/3/2014 ONCOLOGY
EMERGENCY
8/1/2018 MEDICINE
PLASTIC &
RECONSTRUCTIVE
3/1/2017 SURGERY
PULMONARY
MEDICINE
MOUNYAIRY
DALLAS
OPHTHALMOLOGY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
HOUSTON
TX
ACTIVE
1/6/2012 None
N/A
BASTROP
TX
ACTIVE
4/17/2009 None
N/A
HOUSTON
TX
ACTIVE
8/16/2013 None
N/A
LUBBOCK
HOUSTON
TX
TX
ACTIVE
ACTIVE
ACTIVE
3/13/2012 None
6/20/2011 None
12/22/2008 None
N/A
N/A
N/A
TX
ACTIVE
10/24/2011 None
N/A
OK
ACTIVE
LICENSE
ISSUED
12/13/2010 None
N/A
6/4/2010 None
N/A
NEURO-PHYSIOLOGY
(NEUROLOGY)
HOUSTON
OKLAHOMA
INTERNAL MEDICINE CITY
Page 51 of 300
NC
License
Number
P6597
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
CHEN, PHILIP, MD
CHEN, SHERMAN HSIEN-CHANG,
MD
5/15/2013
12/1/2010
5/1/2013
3/1/2013
1/2/2012
P2969
CHEN, TING-YI, MD
CHEN, XIANGBAI , MD
CHEN, YEN I GRACE, MD
CHENG, CHRISTOPHER HAIYUN,
MD
12/1/2015 NEUROLOGY
INFECTIOUS
5/1/2018 DISEASES
3/1/2018 PATHOLOGY
N5619
CHENG, JONATHAN CHI-HONG, MD
4/9/2010
P6356
5/1/2013
8/2/2010
P2427
N0696
CHENG, PANG, MD
CHENNAMANENI, RAJNARSING
RAO, MD
CHENNAREDDY, KIRAN KUMAR,
MD
CHENNU, YAMINI PADMA, MD
5/1/2017 PEDIATRICS
RADIATION
4/9/2015 ONCOLOGY
EMERGENCY
5/1/2018 MEDICINE
3/15/2012
8/29/2008
N8499
CHEPYALA, PAVAN, MD
1/18/2011
N5620
N9031
CHERIAN, VENEETHA , MD
CHERUIYOT, HONEY CHEMUTAI,
MD
P4554
CHEUNG, ERIC, MD
P2214
N9186
CHEUNG, MIN-YUEN CYNTHIA, MD
CHEVURU, SRINIVAS, MD
P6152
CHHABRA, SUMEET KUMAR, MD
P1978
CHHIPWADIA, AMISHA S, MD
N3557
CHI, ANNIE YI-AN , MD
N6221
P4853
CHIADIKA, SIMBO M, MD
CHIKE-OBI, CHUMA , MD
N8172
P6354
P5607
P1739
N7240
5/1/2012
Secondary Specialty
(Self-Designated)
RHINOLOGY
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
SAN ANTONIO TX
ISSUED
DALLAS
CYTOPATHOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/15/2013 None
N/A
TX
ACTIVE
12/23/2010 None
N/A
DALLAS
TX
TEMPLE
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
5/7/2013 None
3/11/2013 None
1/5/2012 None
N/A
N/A
N/A
ACTIVE
6/5/2012 None
N/A
ACTIVE
4/20/2010 None
N/A
5/3/2013 None
N/A
HOUSTON
TX
8/2/2010 None
N/A
HOSPITALIST
8/29/2013 NEUROLOGY
NEUROLOGY
FORT WORTH TX
GASTROENTEROLOG
1/18/2016 Y
INTERNAL MEDICINE
NEURO4/9/2015 NEUROLOGY
OPTHAMOLOGY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/15/2012 None
9/11/2008 None
N/A
N/A
1/18/2011 None
N/A
4/9/2010 None
N/A
3/15/2011
10/1/2012
4/9/2010
3/1/2012
4/1/2011
4/12/2013
2/1/2012
8/21/2009
6/4/2010
11/15/2012
INTERNAL MEDICINE
INTERNAL MEDICINE
PEDIATRIC
NEPHROLOGY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
PEDIATRICS
ELECTROPHYSIOLOG
4/12/2018 Y
CARDIOLOGY
FAMILY PRACTICE
CARDIOVASCULAR
CARDIOVASCULAR
6/4/2015 DISEASES
IMAGING
Page 52 of 300
IRVING
TX
ACTIVE
4/19/2011 None
N/A
HOUSTON
TX
ACTIVE
10/4/2012 None
N/A
LOS ANGELES CA
TEXARKANA
TX
ACTIVE
ACTIVE
3/5/2012 None
4/13/2011 None
N/A
N/A
PLANO
ACTIVE
LICENSE
ISSUED
4/25/2013 None
N/A
2/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
8/27/2009 None
N/A
6/4/2010 None
11/28/2012 None
N/A
N/A
TX
FORT WORTH TX
License
Number
Physician Name
P5163
P6598
CHIKKALA, SUBHA , MD
CHILUVERI, MADHU, MD
N8283
P2615
P1627
CHIN, ERIC JOSEPH, MD
CHIN, MARK MAW-CHANG, MD
CHING, LINA MIRIAM, MD
N7407
CHING, NATASCHA, MD
N6838
N9828
P0564
CHINNAPPAN, RAJ , MD
CHINTA, SHASHI, MD
CHINTALA, NARANATH, MD
CHINTALAPUDI, UDAYA BHASKARA
TM00502 RAO, MD
dicaid
dicaid
Agreement
End Date
Designated)
1/4/2013
5/15/2013
12/15/2010
4/2/2012
12/15/2011
8/16/2010
7/1/2010
6/3/2011
8/1/2011
2/1/2012
N3559
P4555
P7413
CHIOSSI, GIUSEPPE , MD
CHIRACHANCHAI, MIKE GLA, MD
CHIRALA, KARTHIK , MD
8/21/2009
10/1/2012
8/1/2013
P7258
P5787
CHIRANAND, PAULPOJ, MD
CHIRUMAMILLA, NEELIMA, MD
7/15/2013
3/15/2013
P7622
N3561
P1062
8/15/2013
8/21/2009
10/3/2011
P5052
CHISHOLM, SIAN S, MD
CHITTUM, JENNIFER ELLEN , MD
CHITTURI, RADHA KUMARI, MD
CHITWOOD, DARCIE ANDERSON,
DO
DO
DO
N6222
CHIU, CARRIE HERMOSA, MD
P5052
P5052
P5608
CHO, DONG SIK, MD
12/17/2012
12/17/2012
12/17/2012
6/4/2010
3/1/2013
EMERGENCY
12/15/2015 MEDICINE
4/2/2017 CARDIOLOGY
Secondary Specialty
(Self-Designated)
GENERAL
PREVENTIVE
MEDICINE
HOSPITALIST
Disciplinary
Status Date
ACTIVE
ACTIVE
1/14/2013 None
5/17/2013 None
N/A
N/A
TX
MO
TX
ACTIVE
ACTIVE
ACTIVE
1/5/2011 None
4/11/2012 None
12/19/2011 None
N/A
N/A
N/A
AUSTIN
TX
9/6/2010 None
N/A
TOLEDO
FT. WORTH
OH
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
7/1/2010 None
6/21/2011 None
8/5/2011 None
N/A
N/A
N/A
BIRMINGHAM
AL
ACTIVE
2/29/2012 None
N/A
GALVESTON
ALLEN
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
9/1/2009 None
10/4/2012 None
8/5/2013 None
N/A
N/A
N/A
7/15/2013 None
4/1/2013 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
8/19/2013 None
9/29/2009 None
10/28/2011 None
N/A
N/A
N/A
TX
ACTIVE
12/19/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/19/2012 None
N/A
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
12/19/2012 None
N/A
6/4/2010 None
N/A
3/8/2013 None
N/A
HARKER
HEIGHTS
TX
SAN ANTONIO TX
SAN ANGELO
ELECTRODIAGNOSTI
C MEDICINE
MARSHALL
Page 53 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
LONGVIEW
FT. SAM
HOUSTON
INTERNAL MEDICINE FARMINGTON
RHEUMATOLOGY
HOUSTON
PEDIATRIC
8/16/2015 INFECTIOUS DISEASE PEDIATRICS
DIAGNOSTIC
7/1/2015 RADIOLOGY
VASCULAR AND
INTERVENTIONAL
2/1/2017 RADIOLOGY
RADIOLOGY
OBSTETRICS AND
MATERNAL AND
FETAL MEDICINE
OPHTHALMOLOGY 7/15/2018 VITREOUS SURGERY OPHTHALMOLOGY
FAMILY MEDICINE
GASTROENTEROLOG
8/15/2018 Y
GERIATRIC MEDICINE PALLIATIVE
MEDICINE
MEDICINE
MEDICINE
6/4/2015 PEDIATRICS
PHYSICAL MED. &
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N9830
CHO, MICHAEL, MD
6/3/2011
P6799
CHOCKALINGAM, VIJAYARATNA ,
MD
6/3/2013
N5625
CHOE, KEVIN S, MD
4/9/2010
P2838
CHOI, HUIMAHN ALEX, MD
P5946
CHOI, SUNG-HEE, MD
N7068
CHOI, YOU SUK, MD
P3300
CHOKSHI, NITI YOGESH, MD
TM00408 CHONG, CHRISTOPHER LEE, MD
P5347
CHONG, EUMING, MD
P7623
CHONG, JAMES JAY, MD
N7996
CHONG, KOK LEUNG, MD
P3301
CHONG, MICHELLE , MD
4/13/2012
4/1/2013
7/15/2010
6/1/2012
1/18/2011
2/1/2013
8/15/2013
10/29/2010
6/1/2012
P2616
CHOO, JOSHUA HYOSUNG, MD
4/2/2012
P2107
CHOU, SHIH-CHIN, MD
2/10/2012
N4346
CHOUDHRI, MOBEEN NAEEM, MD
11/6/2009
N0701
N2031
N7609
CHOUDHRY, MUHAMMAD IMRAN,
MD
CHOUDHRY, VINEET , MD
CHOUEIRI, MICHEL , MD
8/29/2008
2/6/2009
9/1/2010
P0713
CHOUEIRI, NABIL ELIA, MD
8/15/2011
ENDOCRINOLOGY,
DIABETES AND
6/3/2018 METABOLISM
RADIATION
4/9/2015 ONCOLOGY
Secondary Specialty
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Practice City
Registration
Status of
Practice
Texas
State
License
INTERNAL MEDICINE
DALLAS
TX
CRITICAL CARE NEUROSURGERY
4/13/2017 NEUROLOGY
HEMATOLOGY/ONCOL
4/1/2018 OGY
INTERNAL MEDICINE
ENDOCRINOLOGY,
DIABETES AND
7/15/2015 INTERNAL MEDICINE METABOLISM
PEDIATRICS,
ALLERGY &
6/1/2017 PEDIATRICS
IMMUNOLOGY
1/18/2016 RADIOLOGY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
Disciplinary
Status Date
LICENSE
ISSUED
6/3/2011 None
N/A
LICENSE
ISSUED
6/3/2013 None
N/A
4/28/2010 None
N/A
4/13/2012 None
N/A
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
4/3/2013 None
N/A
GUN BARREL
CITY
TX
ACTIVE
7/20/2010 None
N/A
HOUSTON
TX
ACTIVE
6/27/2012 None
N/A
SACRAMENTO CA
ACTIVE
ACTIVE
ACTIVE
1/25/2011 None
2/6/2013 None
8/16/2013 None
N/A
N/A
N/A
ACTIVE
11/3/2010 None
N/A
ACTIVE
6/5/2012 None
N/A
ACTIVE
4/9/2012 None
N/A
CEDAR HILL
TX
INTERVENTIONAL
RADIOLOGY
PLASTIC &
RECONSTRUCTIVE
SURGERY
EMERGENCY
2/10/2017 MEDICINE
PAIN
MANAGEMENT/REHAB
11/6/2014 MED
PAIN MANAGEMENT
ENDOCRINOLOGY,
DIABETES AND
INTERNAL MEDICINE
GASTROENTEROLOG
8/15/2016 Y
INTERNAL MEDICINE
Page 54 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
FLUSHING
NY
ACTIVE
2/20/2012 None
SEE
PREVIOUS
11/16/2009 ORDER
N/A
HOUSTON
TX
ACTIVE
MARQUETTE
AUSTIN
HOUSTON
MI
TX
TX
ACTIVE
ACTIVE
ACTIVE
9/9/2008 None
2/11/2009 None
9/6/2010 None
N/A
N/A
N/A
TYLER
TX
ACTIVE
8/22/2011 None
N/A
11/9/2009
License
Number
Physician Name
P6599
CHOUFANI, JOE NAJI, MD
N4986
CHOW, JOSEPH LIN YUN, MD
dicaid
dicaid
Agreement
End Date
Designated)
5/15/2013
2/5/2010
N7070
CHOW, PING HOLLAND, MD
7/15/2010
N6224
P5349
CHOW, YVONNE C, MD
CHOWDHURY, ASHWINI, MD
6/4/2010
2/1/2013
P3521
CHOWNING, SCOTT, MD
6/8/2012
P0025
P1628
CHRISTENSEN, HILARY, DO
CHRISTODOULOU,
CHRISTODOULOS , MD
P0714
CHRONISTER, JUSTIN DAVID, DO
P1629
CHRONISTER, STACY, DO
P2619
P4431
P2108
CHU, ETEM TABOGHO, MD
CHU, JEFFREY TING-YUAN, MD
CHU, LEI, MD
4/2/2012
9/17/2012
2/10/2012
P3302
N4347
CHU, RICHARD CHUN HSIEN, DO
CHU, VINCENT , MD
6/1/2012
11/6/2009
N4987
N0702
N4348
N8084
N7530
2/5/2010
8/29/2008
11/6/2009
11/15/2010
8/27/2010
N5628
CHUA, ALBERT JOSEPH, MD
CHUA, MATT JEREMIAH TAN, MD
CHUANG, HUBERT , MD
CHUANG, YI- JU , MD
CHUDEJ, ERIC , MD
CHUGHTAI-HARVEY, ISABELLE
CLAIRE, MD
CHUKWU, IKEDIEZE IGWE, MD
CHUKWUNYERE, EMMANUEL
AMAM, MD
N8284
P3304
CHUMBLEY, CLYDE MARION II, MD
CHUNDRU, VITTAL KUMAR, MD
12/15/2010
6/1/2012
N4350
N2442
6/15/2011
12/15/2011
URGENT CARE
2/5/2015 MEDICINE
EMERGENCY
6/4/2015 MEDICINE
12/15/2011
OBSTETRICS AND
4/2/2017 GYNECOLOGY
2/10/2017 UROLOGIC SURGERY
4/9/2010
11/6/2014 RADIOLOGY
2/5/2015
8/29/2013
11/6/2014
11/15/2015
8/27/2015
FAMILY MEDICINE
INTERNAL MEDICINE
NUCLEAR MEDICINE
RADIOLOGY
FAMILY MEDICINE
Practice City
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
SPORTS MEDICINE GENERAL PRACTICE
PALESTINE
6/8/2017 PEDIATRICS
EMERGENCY
6/15/2016 MEDICINE
ALLERGY AND
12/15/2016 IMMUNOLOGY
8/15/2011
11/6/2009
4/3/2009
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HOSPITALIST
HOSPITALIST
HOSPITALIST
OBSTETRICS AND
Page 55 of 300
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/15/2013 None
N/A
2/5/2010 None
N/A
7/15/2010 None
N/A
6/4/2010 None
2/4/2013 None
N/A
N/A
6/8/2012 None
N/A
6/15/2011 None
N/A
NICOSIA
CORPUS
CHRISTI
CORPUS
CHRISTI
AL
ACTIVE
3/1/2012 None
N/A
TX
ACTIVE
8/22/2011 None
N/A
TX
ACTIVE
1/12/2012 None
N/A
LONGVIEW
TX
ACTIVE
ACTIVE
ACTIVE
4/11/2012 None
9/18/2012 None
2/14/2012 None
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/25/2012 None
11/16/2009 None
N/A
N/A
2/5/2010
12/15/2008
11/17/2009
11/18/2010
9/7/2010
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
11/19/2009 None
4/8/2009 None
N/A
N/A
4/9/2010 None
N/A
ACTIVE
ACTIVE
12/23/2010 None
6/27/2012 None
N/A
N/A
FORT WORTH TX
SAN ANTONIO TX
JERSEY CITY
HOUSTON
NJ
TX
WACO
TX
SACRAMENTO CA
HOUSTON
TX
TAYLOR
TX
License
Number
Physician Name
N8285
CHUNDURI, ANIL KUMAR, MD
CHUNG, CHRISTOPHER PEI-CHIA,
N4988
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
12/15/2010
OBSTETRICS AND
2/5/2010
2/5/2015 GYNECOLOGY
UROGYNECOLOGY
RADIATION
4/1/2011
4/1/2016 ONCOLOGY
Practice City
AKRON
N9188
CHUNG, ERIC, MD
N7243
CHUNG, JAYER, MD
8/2/2010
N2034
CHUNG, STEPHANIE THERESE, MD
2/6/2009
8/2/2015 VASCULAR SURGERY GENERAL SURGERY DALLAS
PEDIATRIC
2/6/2014 INTERNAL MED - PEDS ENDOCRINOLOGY
GALVESTON
N9359
CHUNG, YU LIN IRENE, MD
4/8/2011
N7408
CHWOSCHTSCHINSKY, ELISA , MD
8/16/2010
HOUSTON
N/A
TX
ACTIVE
8/5/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
2/19/2009 None
N/A
4/8/2011 None
N/A
SHREVEPORT LA
ACTIVE
8/30/2010 None
N/A
DENTON
ACTIVE
LICENSE
ISSUED
3/20/2013 None
N/A
4/15/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/15/2010 None
10/11/2010 None
N/A
N/A
7/15/2010 None
N/A
8/1/2011 None
N/A
TX
ACTIVE
ACTIVE
11/16/2009 None
12/29/2011 None
N/A
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
3/3/2009 None
4/29/2010 None
N/A
N/A
MEMPHIS
TN
ACTIVE
1/22/2013 None
N/A
HOLLYWOOD
FL
ACTIVE
LICENSE
ISSUED
12/6/2011 None
N/A
12/1/2010 None
UNDER
BOARD
1/2/2012 ORDER
N/A
4/15/2011
CILENTO, BENJAMIN WEST, MD
CIMPEAN, CLAUDIU ADRIAN, MD
4/9/2010
10/1/2010
OTOLARYN & FACIAL
PLASTIC SURGERY
HOUSTON
ODESSA
7/15/2010
7/15/2015 PALLIATIVE MEDICINE INTERNAL MEDICINE
P0565
CINTRON, ALEXIE, MD
CIRES-DROUET, RAFAEL
SANTIAGO, MD
8/1/2011
N4352
P1630
CISNEROS, LAURA E, MD
CISNEROS, YVET LINDA, MD
11/6/2009
12/15/2011
N1590
N5631
CIUREA, STEFAN OCTAVIAN, MD
CLANTON, DAVID BYRON, MD
12/12/2008
4/9/2010
P5266
CLARK, BRADLY DOUGLAS, MD
1/15/2013
P1531
CLARK, CHERYL ANN, MD
12/1/2011
N8175
CLARK, DAVID WELLES, MD
12/1/2010
8/1/2016 INTERNAL MEDICINE VASCULAR MEDICINE
HEMATOLOGY/ONCOL
11/6/2014 OGY
HEMATOLOGY/ONCOL
12/12/2013 OGY
ANATOMIC
1/15/2018 PATHOLOGY
CYTOPATHOLOGY
PULMONARY
CRITICAL CARE
CRITICAL CARE
MEDICINE
OTORHINOLARYNGOL
12/1/2015 OGY
P1740
CLARK, JAMES ALLEN, MD
3/15/2013
N9441
CIARLO, JACQUE DIANE, DO
N5629
N7787
N7071
1/2/2012
Page 56 of 300
N/A
4/6/2011 None
EMERGENCY
4/15/2016 MEDICINE
CIANCI, CHRISTOPHER BRIAN, DO
2/5/2010 None
ACTIVE
INTERNAL MEDICINE
8/16/2015 RADIOLOGY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/21/2010 None
N/A
TX
INTERVENTIONAL
CARDIOLOGY
EMERGENCY
MEDICINE
P5788
Registration
Status of
Practice
Texas
State
License
OH
ACTIVE
LICENSE
ISSUED
HARLINGEN
WOODVILLE
TX
TX
TX
TX
LICENSE
ISSUED
12/15/2011
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1979
CLARK, SHARONDA NICOLE, MD
2/1/2012
N4989
2/5/2010
P2971
CLARKE, CLARENCE GEORGE, DO
CLARKE, JERMAINE GARNETTE,
DO
P1980
N6841
CLARKE, JONATHAN ERIC, MD
CLAUS, STEPHANIE ELISE, MD
2/1/2012
7/1/2010
N6842
CLAY, MARK ANTHONY, MD
7/1/2010
P0185
CLEARFIELD, DANIEL ADAM, DO
7/1/2011
2/1/2017 PSYCHIATRY
EMERGENCY
2/5/2015 MEDICINE
GASTROENTEROLOG
5/1/2017 Y
EMERGENCY
2/1/2017 MEDICINE
PEDIATRICS,
7/1/2015 CARDIOLOGY
FAMILY
7/1/2016 PRACTICE/OMM
N6226
CLEMENS, MARK WARREN II, DO
6/4/2010
6/4/2015 PALLIATIVE MEDICINE
P0361
7/15/2011
P2973
CLOS, AUDRA LEA, MD
CLOSE, CATHERINE COTTERMAN,
MD
P4744
CLOUD, ROSE JOSEPH, MD
11/1/2012
P3616
5/1/2012
5/1/2012
6/15/2012
N0705
CLULEY, JOHN DAVID, MD
COCHRAN, JEFFREY DWIGHT JR,
MD
P0362
COFFEE, ROBERT EARL III, MD
7/15/2011
N4990
N9034
COFFIE, LINCOLN G, MD
COGAR, BRYAN DEAN, MD
2/5/2010
3/15/2011
P0363
N9530
7/15/2011
5/2/2011
N2446
P2621
COHEN, DAN CHAIM, MD
COHEN, JOSHUA B, MD
COIMBRA, MARIA DE LOURDES
MOUTTA CALADO, MD
COKER, BRIDGETTE DENISE, MD
P0566
COKER, KARAH LYNN, MD
P1533
COLBERT, CHRISTLE DENISE, MD
8/29/2008
Practice City
HOUSTON
INTERNAL MEDICINE SHERMAN
EMERGENCY
MEDICAL SERVICES
WACO
TX
TX
TX
INTERNAL MEDICINE
SPORTS MEDICINE
(FAMILY PRACTICE) FORT WORTH TX
7/15/2016 UNSPECIFIED
MIDLAND
GASTROENTEROLOG
6/15/2017 Y
EMERGENCY
8/29/2013 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
GASTROENTEROLOG
7/15/2016 Y
4/3/2009
4/2/2012
8/1/2011
PHYSICAL MED. &
12/1/2011
Secondary Specialty
(Self-Designated)
CHILD AND
ADOLESCENT
PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
TX
EMERGENCY
MEDICINE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/1/2012 None
N/A
2/5/2010 None
N/A
5/3/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
2/8/2012 None
7/13/2010 None
N/A
N/A
7/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/8/2011 None
N/A
6/4/2010 None
N/A
7/15/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/8/2012 None
N/A
11/1/2012 None
N/A
6/15/2012 None
N/A
TEMPLE
TX
ACTIVE
9/26/2008 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/15/2011 None
N/A
2/5/2010 None
3/31/2011 None
N/A
N/A
8/1/2011 None
6/3/2011 None
N/A
N/A
CARDIOLOGY
INTERNAL MEDICINE TEMPLE
HOUSTON
TX
TX
ACTIVE
ACTIVE
INTERNAL MEDICINE MCALLEN
GARLAND
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
5/18/2009 None
4/9/2012 None
N/A
N/A
8/1/2011 None
N/A
ACTIVE
12/5/2011 None
N/A
SAN ANTONIO TX
Page 57 of 300
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
PLASTIC &
RECONSTRUCTIVE
OTORHINOLARYNGO
9/15/2011
9/15/2016 SURGERY
LOGY
GALVESTON
DERMATOPATHOLO
7/1/2010
7/1/2015 PATHOLOGY
GY
P0968
COLE, ERIC LOWRY, MD
N6843
COLE, RYAN NEIL, MD
P4558
N9192
COLEMAN, ALAN MICHAEL, MD
COLEN, JOHN SHERMAN, MD
P5949
COLLADO, CARLA, MD
4/1/2013
P7416
COLLEN, JACOB FREDRICK, MD
8/1/2013
PULMONARY
CRITICAL CARE
8/1/2018 DISEASES
MEDICINE (IM)
N4992
COLLIER, JOHN TOM JR, MD
2/5/2010
P3305
COLLINS, AISHA RENEE, MD
6/1/2012
P6361
N2038
COLLINS, CHRISTOPHER JOEL, MD
COLQUE, MOLLY JOY, MD
COLVIN, BRADLEY CHRISTOPHER,
MD
COMPTON, LINDSAY
MATWIJECKY, MD
COMPTON-JOSEPH, BRANDI
ANTOINETTE, MD
5/1/2013
2/6/2009
OBSTETRICS AND
6/3/2018 GYNECOLOGY
P6802
N2993
P3524
10/1/2012
4/1/2011
6/3/2013
5/29/2009
6/8/2012
TX
4/1/2016 UROLOGIC SURGERY UROLOGY
HOSPITALIST
CRANIOFACIAL
2/1/2018 SURGERY
CONE, JEFFREY DONALD JR, MD
2/1/2013
P5789
3/15/2013
N5634
CONNALLY, PATRICIA AILEEN, DO
CONNAUGHTON, JAMES
CHRISTOPHER, MD
N8899
CONNEALY, BRENDAN DANIEL, MD
3/1/2011
COLON AND RECTAL
4/9/2015 SURGERY
OBSTETRICS AND
3/1/2016 GYNECOLOGY
P5950
P1064
CONNER, JAMES MICHAEL, MD
CONNOR, BRYNNA , MD
4/1/2013
10/3/2011
HOUSTON
TX
SAN ANTONIO TX
LONGVIEW
DENVER
WA
CO
SHREVEPORT LA
5/29/2014 RADIOLOGY
OBSTETRICS AND
6/8/2017 GYNECOLOGY
P5350
4/9/2010
Registration
Status of
Practice
Texas
State
License
PLASTIC &
RECONSTRUCTIVE
SURGERY
FP/OSTEO
MANIPULATION
MEDICINE
Disciplinary
Status Date
9/28/2011 None
N/A
7/1/2010 None
N/A
12/30/2012 None
4/8/2011 None
N/A
N/A
ACTIVE
4/4/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/6/2013 None
N/A
2/5/2010 None
N/A
6/1/2012 None
N/A
ACTIVE
ACTIVE
5/7/2013 None
2/12/2009 None
N/A
N/A
ACTIVE
7/8/2013 None
N/A
ACTIVE
6/4/2009 None
N/A
HOUSTON
TX
ACTIVE
6/13/2012 None
N/A
TAMPA
FL
ACTIVE
2/11/2013 None
N/A
GILLETTE
WY
ACTIVE
3/19/2013 None
N/A
5/3/2010 None
N/A
3/1/2011 None
N/A
4/19/2013 None
11/16/2011 None
N/A
N/A
MATERNAL AND
FETAL MEDICINE
COLON AND RECTAL
SURGERY
TEMPLE
TX
FAMILY PRACTICE
AUSTIN
TX
Page 58 of 300
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
License
Number
N2994
N0706
Physician Name
CONNOR, JEANMARIE BURIGO ,
MD
CONNOR, MICHAEL ADAM, MD
P7090
CONRAD, CLAUDIUS, MD
dicaid
dicaid
Agreement
End Date
Designated)
5/29/2009
8/29/2008
7/1/2013
N6231
CONROY, MELINDA DAWN, DO
N3574
P0365
N5636
CONROY, STEVEN MICHAEL, DO
CONSTANTINE, MATTHEW
WAYNE, MD
CONTRERAS, ALEJANDRO , MD
N6844
CONTRERAS, GAIL EVON, MD
7/1/2010
P6362
CONTRERAS, JAMIE JAQUA, MD
5/1/2013
P7624
CONTRERAS, JORGE IVAN, MD
8/15/2013
N9194
N9834
CONTRERAS, YVONNE MARIE, MD
COOK, CASSY LYNN, MD
4/1/2011
6/3/2011
N2449
4/3/2009
N9195
COOK, PATRICK RUSSELL, DO
COOK-NORRIS, ROBERT HARRY,
MD
P4745
COOLE, SCOTT JOSEPH, DO
P0820
COOLEY, CRAIG, MD
TM00464 COOLEY, PETER ALEXANDER, MD
P2622
COOPER, DAVID M, MD
N7999
COOPER, EDWARD CLISSOLD, MD
P1981
N3577
COOPER, JAMES KEITH, MD
COOPER, MARCINA, MD
6/4/2010
8/21/2009
7/15/2011
4/9/2010
SURGICAL
7/1/2018 ONCOLOGY
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
7/15/2016 MEDICINE
4/9/2015 PATHOLOGY
PALLIATIVE
PEDIATRIC
EMERGENCY
OTORHINOLARYNGOL OTOLARYNGIC
8/15/2018 OGY
ALLERGY
6/3/2016 RADIOLOGY
NEURO-RADIOLOGY
8/26/2011
8/15/2011
8/15/2016 RADIOLOGY
11/1/2012
4/2/2012
10/29/2010
2/1/2012
8/21/2009
Practice City
AUSTIN
TX
HOUSTON
TX
DERMATOLOGIC
SURGERY
4/3/2014 VASCULAR SURGERY
DERMATOLOGIC
4/1/2016 SURGERY
PULMONARY
CRITICAL CARE
11/1/2017 MEDICINE
EMERGENCY
8/26/2016 MEDICINE
4/1/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
6/8/2009 None
9/26/2008 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/31/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
8/31/2009 None
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
7/20/2011 None
5/3/2010 None
N/A
N/A
ACTIVE
7/12/2010 None
N/A
5/6/2013 None
N/A
PLANO
TX
ACTIVE
EL PASO
TX
8/16/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/1/2011 None
6/13/2011 None
N/A
N/A
TX
ACTIVE
5/21/2009 None
N/A
ACTIVE
4/6/2011 None
N/A
ACTIVE
12/10/2012 None
N/A
ACTIVE
LICENSE
ISSUED
8/31/2011 None
N/A
8/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/5/2012 None
N/A
10/29/2010 None
N/A
2/16/2012 None
8/26/2009 None
N/A
N/A
MESA
AZ
SAN ANTONIO TX
PAIN
MANAGEMENT/REHA
B MED
ROCKWALL
EDMOND
SUGARLAND
Page 59 of 300
ACTIVE
ACTIVE
TX
DERMATOLOGY
DIAGNOSTIC
2/1/2017 RADIOLOGY
Disciplinary
Status Date
AUSTIN
GENERAL SURGERY EL PASO
EMERGENCY
MEDICAL SERVICES
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
OK
TX
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N7912
COOPER, MICHAEL ANDREW, MD
10/15/2010
N9443
COOPER, MICHAEL CRONIN, MD
4/15/2011
P5352
N7913
COPELAND, DANIEL REID, MD
CORCORAN, JACQUELINE ESTEE,
DO
10/15/2010
P1174
CORDERO, BRUNILDA, MD
10/17/2011
P7092
CORDOBA KISSEE, MICHELLE
LYNN, MD
P1285
CORNELIUS, BEATRIZ , MD
N6846
CORNWELL, LORRAINE D, MD
7/1/2010
P1983
CORNWELL, WILLIAM KENT III, MD
2/1/2012
P1536
CORONA, RITA ESMERALDA, MD
12/1/2011
N7244
CORPUZ, GODDY TAPANG, MD
N3579
CORRELL, BODIE JAMES, MD
P7626
N9196
P1450
CORRIGAN, DEVLYN, DO
CORRIGAN, NICOLE JULIA, MD
COSGROVE, AMY DANIELLE, MD
P1984
COSS, ELIZABETH , MD
P7627
COSSEY, LARRY NICHOLAS, MD
8/15/2013
N8177
N5639
COTE, ADAM ZEIHER, DO
COTTER, HEATH EARL, MD
12/1/2010
4/9/2010
ANATOMIC
8/15/2018 PATHOLOGY
ORTHOPEDIC
12/1/2015 SURGERY
P6960
COTTRELL, RICHARD ALLEN, DO
6/14/2013
2/1/2013
7/1/2013
11/4/2011
8/2/2010
8/21/2009
8/15/2013
4/1/2011
11/15/2011
2/1/2012
PEDIATRIC
EMERGENCY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
PEDIATRIC
ENDOCRINOLOGY,
DIABETES AND
7/1/2018 METABOLISM
THORACIC
CARDIOVASCULAR
7/1/2015 SURGERY
PEDIATRICS
INTERNAL MEDICINE EDINBURG
TX
8/2/2015 PEDIATRICS
HOSPITALIST
EMERGENCY
8/15/2018 MEDICINE
4/1/2016 PEDIATRICS
N/A
2/6/2013 None
N/A
10/15/2010 None
N/A
ACTIVE
11/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
7/10/2013 None
N/A
11/4/2011 None
N/A
7/1/2010 None
N/A
DALLAS
TX
ACTIVE
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
TEMPLE
GENERAL PRACTICE MIDLAND
TX
ACTIVE
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
OBSTETRICS
FORT WORTH TX
GASTROENTEROLOG
Y
Page 60 of 300
4/15/2011 None
LICENSE
ISSUED
GENERAL SURGERY
CARDIOLOGY
N/A
ACTIVE
LICENSE
ISSUED
FAYETTEVILLE NC
LITTLE ROCK
AR
Disciplinary
Status Date
10/15/2010 None
LICENSE
ISSUED
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
2/6/2012 None
UNDER
BOARD
12/5/2011 ORDER
N/A
11/21/2011
8/2/2010 None
N/A
9/25/2009 None
N/A
8/23/2013 None
4/11/2011 None
11/17/2011 None
N/A
N/A
N/A
2/1/2012 None
N/A
8/21/2013 None
N/A
12/15/2010 None
4/21/2010 None
N/A
N/A
6/14/2013 None
N/A
License
Number
Physician Name
P1743
COURTNEY, KEVIN DALE, MD
P6363
dicaid
dicaid
Agreement
End Date
Designated)
1/2/2012
1/2/2017 ONCOLOGY
8/21/2009
P6364
COVINGTON, BILL RAY, MD
COVINGTON, CANDACE YVONNE,
MD
COVINGTON, JACQUELYN ROSE,
MD
N0708
COWAN, CRAIG BRUCE II, DO
8/29/2008
P1175
COWDEN, COURTNEY HOLT III, MD
P7262
COX, DERRICK DIONE, MD
7/15/2013
P1286
COX, JOHN A, MD
11/4/2011
N6236
N1293
COX, LYNDSEY ALISON, MD
COX, NATASHA LANAI, MD
N3582
COX, RONALD LEE , MD
P0189
COYNER, KATHERINE JUNE, MD
7/1/2011
P5952
P0898
4/1/2013
9/1/2011
N2042
CRAIG, ELIZABETH STIRLING, MD
CRAIG, JOHN ANTHONY, MD
CRANDALL, ERIC BRINGHURST,
MD
P2842
CRANE, ERIN KING, MD
P0568
CRAWFORD, HEATHER PAIGE, MD
8/1/2011
8/1/2016 PEDIATRICS
N4996
2/5/2010
2/5/2015 RADIOLOGY
P0821
CREEL, CHRISTOPHER, MD
CREIGHTON, CHRISTOPHER
PRICE, MD
8/26/2011
N4364
CRIM, CHAD DAVID, MD
8/15/2013
N8636
CRISTIA, CRISTAL , MD
2/4/2011
EMERGENCY
2/4/2016 MEDICINE
N3581
5/1/2013
5/1/2013
10/17/2011
6/4/2010
10/10/2008
8/21/2009
2/6/2009
4/13/2012
Secondary Specialty
(Self-Designated)
EMERGENCY
8/29/2013 MEDICINE
SURGICAL
7/15/2018 ONCOLOGY
RADIATION
11/4/2016 ONCOLOGY
PEDIATRIC ANES
6/4/2015 (PEDS)
ALLERGY AND
ORTHOPEDIC
7/1/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/1/2018 SURGERY
EMERGENCY
2/6/2014 MEDICINE
GYNECOLOGIC
4/13/2017 ONCOLOGY
Practice City
DALLAS
COLLEGE
STATION
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
5/10/2013 None
N/A
HOUSTON
COLLEGE
STATION
TX
ACTIVE
12/4/2009 None
N/A
TX
ACTIVE
5/10/2013 None
N/A
TEMPLE
TX
ACTIVE
10/8/2008 None
N/A
ACTIVE
11/9/2011 None
N/A
TX
ACTIVE
7/24/2013 None
N/A
GALVESTON
TX
11/11/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
6/4/2010 None
3/31/2009 None
N/A
N/A
ROCKDALE
TX
ACTIVE
9/14/2009 None
N/A
DALLAS
TX
ACTIVE
7/7/2011 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
4/3/2013 None
9/6/2011 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
2/26/2009 None
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
4/17/2012 None
N/A
8/1/2011 None
N/A
2/5/2010 None
N/A
8/26/2011 None
N/A
8/15/2013 None
N/A
2/4/2011 None
N/A
KANSAS CITY MO
GENERAL SURGERY EL PASO
ANESTHESIOLOGY
PEDIATRICS
SPORTS MEDICINE ORTHOPEDICS
TX
MEDICAL GENETICS
PAIN MEDICINE
WACO
Page 61 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/20/2012 None
N/A
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6600
CRISTOBAL, RONALD SALAMAT,
MD
CRITCHLOW, ALLISON LINDSEY,
DO
N5643
CRONE, MICHAEL ROSS, MD
P2109
CROSS, ALISA A, MD
2/10/2012
P2844
P4433
CROSS, MATTHEW WELDON, MD
CROTTY, KEVIN PATRICK, DO
N7788
CROWDER, JASON BRADLEY, MD
P0190
CRUM, ALISON VOIGT, MD
CRUMBAKER, MARIAH LINDSEY,
MD
CRUZ CARRERAS, MARIA TERESA,
MD
P3137
P5953
N1294
5/15/2012
5/15/2013
4/9/2010
N/A
4/9/2010 None
N/A
2/10/2012 None
N/A
GULFPORT
MS
ACTIVE
10/13/2010 None
N/A
TX
ACTIVE
8/1/2011 None
N/A
FORT WORTH TX
ACTIVE
4/8/2013 None
N/A
HOUSTON
TX
10/16/2008 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
6/3/2011 None
11/5/2009 None
N/A
N/A
TYLER
TX
ACTIVE
8/27/2009 None
N/A
WASHINGTON DC
GOODLETTSVI
LLE
TN
ACTIVE
4/23/2012 None
N/A
ACTIVE
5/10/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
8/19/2010 None
10/22/2009 None
10/7/2009 None
N/A
N/A
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/5/2008 None
N/A
6/4/2010 None
N/A
7/1/2011
4/1/2013
10/10/2008
TM00508 CUNNEELY, KEVIN PATRICK, MD
5/1/2012
CYRUS, ARTHUR CLIVE, MD
4/9/2015 UROLOGY
7/4/2013 None
10/1/2015 RADIOLOGY
4/13/2012
N6241
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/1/2010
CULLINAN, PATRICK COREY, DO
CURZON, CHRISTOPHER LEE, DO
MO
N/A
N/A
N/A
8/21/2009
N0715
COLUMBIA
5/23/2012 None
4/18/2012 None
9/25/2012 None
CULLEN, SHAWN , MD
CURRIE, OSCAR JOVAN, MD
ACTIVE
ACTIVE
ACTIVE
N3586
N5000
TX
Disciplinary
Status Date
SAN ANTONIO TX
FORT HOOD
TX
6/3/2011
8/21/2009
CUNNINGHAM, KELLY EILEEN, MD
CURBELO, NIURKA , MD
CURBOW, AMIE RACHELLE, MD
AUSTIN
Registration
Status Date
4/13/2012
9/17/2012
CUELLAR, AUGUSTO, MD
CUERVO, LUIS JAIME, MD
N7410
N3588
N3589
Practice City
Disciplinary
Status of
Texas
License
EMERGENCY
4/13/2017 MEDICINE
N9838
N3585
P2845
Secondary Specialty
(Self-Designated)
CHILD AND
ADOLESCENT
PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
8/16/2010
8/21/2009
8/21/2009
2/5/2010
8/29/2008
6/4/2010
OPHTHALMOLOGY RECONST SURGERY DALLAS
6/3/2016 THORACIC SURGERY
EMERGENCY
8/21/2014 MEDICINE
INTERNAL MED 4/13/2017 EMERGENCY MED
DIAGNOSTIC
5/1/2017 RADIOLOGY
ORTHOPEDIC
2/5/2015 SURGERY
PEDIATRICS,
EMERGENCY
6/4/2015 MEDICINE
VASCULAR
SURGERY
CRITICAL CARE
MEDICINE
EL PASO
CONROE
PEDIATRICS,
CARDIOLOGY
Page 62 of 300
TX
TX
SAN ANTONIO TX
License
Number
Physician Name
N2998
CZARNIK, ANN CLARICE , MD
P6153
DABIRI, TAJUDEEN O, MD
N7076
DABU, DARNEL VIRAY, MD
N6848
DACI, KUANG, MD
P0969
DACUMOS, NANETTE REYES, MD
N8900
DADOUCH, HACHEM, MD
P1634
DAFTARY, AMEET SHIRISH, MD
P5168
DAGNEW, ELIAS, MD
N3592
N1602
D'AGOSTINO, DARRIN
CHRISTOPHER, DO
DAGOSTINO, JANET LYNN, DO
N1600
P4640
D'AGOSTINO, SABINO JOSEPH, DO
DAILEY GARNES, NATALIE JANINE
MIRIAM, MD
P2625
DALMACION-LAYNO, GRACE, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
5/29/2009
5/29/2014 MEDICINE
OBSTETRICS AND
4/12/2013
7/15/2010
7/1/2010
9/15/2011
3/1/2011
12/15/2011
1/4/2013
8/21/2009
12/12/2008
EMERGENCY
3/1/2016 MEDICINE
PEDIATRIC
NEUROLOGICAL
1/4/2018 SURGERY
5/2/2011
P5955
DAMTEW, AHMED M, MD
4/1/2013
4/1/2018 PSYCHIATRY
N6243
DANDAMUDI, SAROJA, MD
6/4/2010
P0716
DANDAN, MELHEM, MD
P7630
N9360
8/15/2013
4/8/2011
KILLEEN
TX
OBSTETRICS AND
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/19/2013 None
N/A
7/15/2010 None
N/A
7/1/2010 None
N/A
ACTIVE
9/21/2011 None
N/A
ACTIVE
3/7/2011 None
N/A
UT
ACTIVE
12/29/2011 None
N/A
SUWANEE
NEUROMUSCULOSK
ELETAL
MEDICINE/OMT
FT. WORTH
FAMILY MEDICINE
SAN ANGELO
GA
ACTIVE
2/13/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
8/28/2009 None
12/29/2008 None
N/A
N/A
SAN ANGELO
TX
ACTIVE
12/29/2008 None
N/A
HOUSTON
FAR
ROCKAWAY
TX
ACTIVE
10/23/2012 None
N/A
NY
ACTIVE
4/18/2012 None
N/A
ACTIVE
5/5/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/10/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
8/22/2011 None
N/A
2/8/2013 None
N/A
8/15/2013 None
4/14/2011 None
N/A
N/A
MADISONVILL
E
TX
INTERNAL MED PEDS
FACIAL PLASTIC
SURGERY
ADDICTION
PSYCHIATRY
SALT LAKE
CITY
GILROY
CA
FAMILY MEDICINE
CRITICAL CARE
MEDICINE
2/8/2018 CARDIOLOGY
Disciplinary
Status Date
N/A
SLEEP MEDICINE
4/2/2012
2/8/2013
ACTIVE
INTERNAL MEDICINE
DAMMERT, MARK OLIVER, MD
DANDAPANTULA, HARI KUMAR, MD
DANESHFAR, BAHRAUM DANIEL,
MD
DANG, HONG, MD
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
6/5/2009 None
URGENT CARE FAMILY PRACTICE
N9533
M9947
KILLEEN
10/15/2012
8/15/2011
Practice City
NEUROLOGICAL
12/12/2013 SURGERY
INFECTIOUS
10/15/2017 DISEASES
12/12/2008
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
DALLAS
HOSPITALIST
Page 63 of 300
TX
License
Number
Physician Name
N8901
DANG, HUNG HOANG, DO
P5058
DANG, MATTHEW K, MD
P5058
DANG, MATTHEW K, MD
P5058
P7419
P1985
DANG, MATTHEW K, MD
DANG, NATALIE MYLAN, MD
DANG, TAM II, MD
P0822
DANIEL, HELEN CHARISSE, MD
N6244
DANISH, ROBERT K, MD
P1856
DANNA, JOSEPH RICHARD, MD
P5526
P2626
DAO, BAO DUY, MD
DAO, HARRY JR, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
3/1/2011
3/1/2016 MEDICINE
DIAGNOSTIC
12/17/2012
DIAGNOSTIC
12/17/2012
NEURO-RADIOLOGY
DIAGNOSTIC
12/17/2012
NEURO-RADIOLOGY
8/1/2013
2/1/2012
OPHTHALMOLOGY
8/26/2011
1/17/2012
PEDIATRIC
EMERGENCY
1/17/2017 MEDICINE
2/8/2013
4/2/2012
6/4/2010
P0366
P7095
DAO, MINH DUY, MD
DAR, KHOLA HAMEED, MD
7/15/2011
7/1/2013
7/15/2016
7/1/2018
P2627
N4369
DAR, WASIM AKRAM, MD
DARAMOLA, JOHN, MD
4/2/2012
11/6/2009
4/2/2017
11/6/2014
P2628
N2462
DARBY, JOHN BYRON, MD
DARHOWER, ADRIENNE MONIQUE,
MD
P7756
DARLING, MATTHEW JAMES, DO
8/30/2013
N7246
DARWISH, ASHRAF HAMZEH, MD
8/2/2010
P4560
DAS, BIDHAN, MD
10/1/2012
P2629
DAS, DIPAN , MD
4/2/2012
4/2/2012
4/3/2009
OBSTETRICS AND
GYNECOLOGY
FAMILY PRACTICE
TRANSPLANT
SURGERY
INTERNAL MEDICINE
4/2/2017 PEDIATRICS
EMERGENCY
4/3/2014 MEDICINE
PEDIATRICS,
ORTHOPEDIC
8/2/2015 SURGERY
COLON AND RECTAL
10/1/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/2/2017 SURGERY
Practice City
ACTIVE
LICENSE
ISSUED
THE
WOODLANDS
THE
WOODLANDS
HOUSTON
EL PASO
LONGVIEW
OBSTETRICS &
GYNECOLOGICAL
SURGERY
FAMILY MEDICINE
Page 64 of 300
3/17/2011 None
N/A
12/17/2012 None
N/A
1/22/2013 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/22/2013 None
8/8/2013 None
2/13/2012 None
N/A
N/A
N/A
8/26/2011 None
N/A
6/4/2010 None
N/A
2/6/2012 None
N/A
2/8/2013 None
4/10/2012 None
N/A
N/A
7/22/2011 None
7/15/2013 None
N/A
N/A
4/4/2012 None
11/16/2009 None
N/A
N/A
4/2/2012 None
N/A
ACTIVE
4/15/2009 None
N/A
TX
ACTIVE
9/9/2013 None
N/A
TX
ACTIVE
9/13/2010 None
N/A
TX
ACTIVE
10/26/2012 None
N/A
ACTIVE
4/9/2012 None
N/A
TX
CLEVELAND
OH
ACTIVE
LICENSE
ISSUED
ACTIVE
AUSTIN,
TX
ACTIVE
ACTIVE
Disciplinary
Status Date
ACTIVE
TX
INTERNAL MEDICINE
URGENT CARE
FT SAM
MEDICINE
HOUSTON
ORTHOPEDIC
SURGERY OF THE
SPINE
PLANO
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
KILLEEN, TX
GENERAL SURGERY ATLANTA
HOSPITALIST
GREENVILLE
HAND SURGERY PLASTIC SURGERY
Registration
Status of
Practice
Texas
State
License
GA
SC
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
N4370
N1604
DAS, SUBHASH CHANDRA, MD
DASARI, VIJAYA MADHAVI, MD
N8902
DATES, CRAIG ALEXANDER, MD
P2224
N7412
P2225
P3309
N1299
N5644
N8903
DATLA, SIREESHA, MD
DAUD AGUERO, BENJAMIN YEMIZ,
MD
DAUM, ALLISON NICOLE, MD
DAVALOS, KARLA DIAZ, MD
DAVE, KAPIL JAGDISHCHANDRA,
MD
DAVENPORT, CRYSTAL MICHELLE,
MD
dicaid
dicaid
Agreement
End Date
Designated)
11/6/2009
12/12/2008
3/1/2011
EMERGENCY
3/1/2016 MEDICINE
3/1/2012
8/16/2010
6/1/2012
EMERGENCY
3/1/2017 MEDICINE
PULMONARY
CRITICAL CARE
6/1/2017 MEDICINE
10/10/2008
3/1/2012
4/9/2010
4/9/2015 PEDIATRICS
3/1/2011
N4372
DAVENPORT, DANIEL FLOYD, MD
DAVENPORT, DOMINIQUE
CONSTANZA, DO
11/6/2009
P0031
DAVER, NAVAL GUSTAD, MD
6/15/2011
N6122
DAVID, EMILIA , MD
P0032
DAVID, HENRY W, MD
N8288
DAVID, ROCHELLE MARIE, MD
P6154
DAVIDSON, JOSEPH LELAND, MD
6/4/2010
6/15/2011
12/15/2010
4/12/2013
Practice City
GRASONVILLE MD
EMERGENCY
MEDICINE
AMARILLO
DAVIES, SUMMER DANIELLE, MD
2/1/2013
2/1/2018 PEDIATRICS
N6248
DAVILA ARROYO, HIMARA, MD
DAVILA RODRIGUEZ, AMANDA
SOFIA, MD
6/4/2010
4/1/2013
4/1/2018 PEDIATRICS
4/8/2011 None
N/A
3/1/2012 None
N/A
3/8/2012 None
N/A
TX
LICENSE
ISSUED
6/1/2012 None
N/A
HOSPITALIST
TX
ACTIVE
1/19/2009 None
N/A
SAN ANTONIO TX
LACKLAND
AFB
TX
ACTIVE
4/30/2010 None
N/A
ACTIVE
3/7/2011 None
N/A
TX
ACTIVE
1/25/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/20/2011 None
N/A
6/4/2010 None
N/A
6/15/2011 None
N/A
DERMATOPATHOLO
GY
P5354
ACTIVE
LICENSE
ISSUED
ACTIVE
4/3/2014 PATHOLOGY
N/A
N/A
N/A
6/4/2015 PEDIATRICS
EMERGENCY
6/15/2016 MEDICINE
OBSTETRICS AND
4/3/2009
11/6/2009 None
2/27/2009 None
9/1/2010 None
KILLEEN
HEMATOLOGY/ONCOL
6/15/2016 OGY
INTERNAL MEDICINE HOUSTON,
DAVIE, JAMES ROBERT , MD
Disciplinary
Status Date
ACTIVE
ANGLETON
Page 65 of 300
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
URGENT CARE
MEDICINE
AEROSPACE
MEDICINE
N2463
P5957
Secondary Specialty
(Self-Designated)
INTERNAL MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
SAN ANTONIO TX
ACTIVE
12/23/2010 None
N/A
SAN ANTONIO TX
ACTIVE
4/15/2013 None
N/A
DALLAS
TX
ACTIVE
4/14/2009 None
N/A
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/11/2013 None
N/A
6/4/2010 None
N/A
4/1/2013 None
N/A
License
Number
Physician Name
P0570
DAVIS, GLENA JUNE, DO
N1301
N5645
DAVIS, JOHN WILLIAM III, MD
DAVIS, KURTIS WILLIAM, MD
P7421
P0367
N7916
P1857
DAVIS, LANCE LEE, MD
DAVIS, LESLEY JOY, MD
DAVIS, LINDA MARLENE BOLLING,
MD
DAVIS, MICHAEL ROBERT, MD
N3603
DAVIS, RACHEL ANN, MD
P2630
DAVIS, REINA DANICA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
8/1/2011
8/1/2016 GYNECOLOGY
CARDIOVASCULAR
10/10/2008
10/10/2013 SURGERY
THORACIC SURGERY
4/9/2010
FAMILY PRACTICE
UNDERSEA AND
HYPERBARIC MED
8/1/2013
8/1/2018 (PREV MED)
FAMILY MEDICINE
7/15/2011
10/15/2010
1/17/2012
8/21/2009
4/2/2012
P7422
DAVIS, RYAN WILLIAM, MD
8/1/2013
N8181
N8087
DAVIS, WILLIAM GRANT, MD
DAVOUDIAN, VAHEH, MD
P5527
DAY, ARTHUR LINWOOD, MD
2/8/2013
P5792
DAY, CEDRIC TARRYL JR, MD
3/15/2013
P7757
P5169
DAY, CYNTHIA MADISON, MD
DAYANI, ARIA, MD
8/30/2013
1/4/2013
P6601
DAYE, SUHAIL SAMI, MD
5/15/2013
P1451
N9534
D'COSTA, QUEENIE MOUSUMI, MD
DE GOLOVINE, ALEKSANDRA
MARIA, MD
P1858
DE GORORDO ARZAMENDI,
ANTONIO, MD
N8088
P4641
P6155
DE GROOT, PATRICIA M, MD
DE JESUS, MARIA AUDRIE, MD
DE LA MORA, DIEGO , MD
12/1/2010
11/15/2010
11/15/2011
5/2/2011
1/17/2012
11/15/2010
10/15/2012
4/12/2013
OBSTETRICS AND
4/2/2017 PEDIATRICS
DIAGNOSTIC
8/1/2018 RADIOLOGY
ANATOMIC/CLINICAL
12/1/2015 PATHOLOGY
NEUROLOGICAL
2/8/2018 SURGERY
OBSTETRICS AND
DIAGNOSTIC
8/30/2018 RADIOLOGY
PEDIATRIC CRITICAL
Registration
Status of
Practice
Texas
State
License
OTHER SPECIALTY
ABDOMINAL
SURGERY
5/2/2016 NEPHROLOGY
PULMONARY
CRITICAL CARE
1/17/2017 MEDICINE
INTERNAL MEDICINE
CARDIOTHORACIC
DIAGNOSTIC
RADIOLOGY
Page 66 of 300
Disciplinary
Status Date
Practice City
MINERAL
WELLS
TX
ACTIVE
8/5/2011 None
N/A
CONROE
BRYAN
TX
TX
ACTIVE
ACTIVE
11/3/2008 None
5/3/2010 None
N/A
N/A
CHARLESTON
KATY
MISSION
VIEJO
SAN ANTONIO
SC
TX
ACTIVE
ACTIVE
8/5/2013 None
8/1/2011 None
N/A
N/A
CA
TX
ACTIVE
ACTIVE
10/25/2010 None
1/23/2012 None
N/A
N/A
HUMBLE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/31/2009 None
N/A
4/2/2012 None
N/A
8/1/2013 None
N/A
TYLER
TX
CARROLLTON TX
ACTIVE
ACTIVE
1/21/2011 None
12/8/2010 None
N/A
N/A
HOUSTON
TX
ACTIVE
2/13/2013 None
N/A
TEMPLE
TX
ACTIVE
3/20/2013 None
N/A
SAN ANTONIO TX
CLARKSVILLE TX
ACTIVE
ACTIVE
9/9/2013 None
1/11/2013 None
N/A
N/A
MASSENA
NY
ACTIVE
5/23/2013 None
N/A
TEMPLE
TX
ACTIVE
11/23/2011 None
N/A
HOUSTON
TX
ACTIVE
5/10/2011 None
N/A
BOSTON
MA
ACTIVE
2/17/2012 None
N/A
RICHMOND
GREENVILLE
DALLAS
VA
TX
TX
ACTIVE
ACTIVE
ACTIVE
12/6/2010 None
11/28/2012 None
4/26/2013 None
N/A
N/A
N/A
EMERGENCY/TRAUM
A RADIOLOGY
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
P6370
Physician Name
DE LA ROSA PEREZ, DEENI LUZ,
MD
dicaid
dicaid
Agreement
End Date
Designated)
7/1/2010
N5007
DE LA ROZA, GUSTAVO LUIS, MD
DE LA TORRE, JAVIER EDUARDO,
MD
5/1/2018 PEDIATRICS
ANATOMIC
7/1/2015 PATHOLOGY
2/5/2010
N9535
DE LEON, HECTOR EDUARDO, MD
5/2/2011
5/2/2016 PEDIATRICS
P1287
P0899
DE LEON, OSCAR , MD
DE LOS SANTOS, BILLY A, MD
11/4/2011
9/1/2011
P7758
DE LOS SANTOS, DANIEL , MD
8/30/2013
N7247
DE LOS SANTOS, HUMBERTO
ANGEL, MD
8/2/2010
J4768
P6805
N3002
DE LOS SANTOS, MARCO
ANTONIO, MD
DE MARCO, BRENDAN MICHAEL,
MD
AM00024 DE MASI, LEON GREGORY, MD
DE OLIVEIRA, LUCIANA FONSECA,
N2054
MD
5/1/2013
6/3/2013
5/29/2009
Secondary Specialty
(Self-Designated)
10/15/2012
10/15/2017
2/6/2009
2/6/2014
TX
ACTIVE
5/17/2013 None
N/A
CYTOPATHOLOGY
SYRACUSE
NY
7/16/2010 None
N/A
2/5/2010 None
N/A
5/2/2011 None
N/A
11/4/2011 None
9/6/2011 None
N/A
N/A
MESQUITE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
HOUSTON
TX
ACTIVE
9/10/2013 None
N/A
DALLAS
TX
ACTIVE
8/11/2010 None
N/A
6/3/2013 None
N/A
ACTIVE
6/17/2009 None
N/A
ACTIVE
10/23/2012 None
N/A
TX
ACTIVE
2/17/2009 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
6/13/2013 None
5/6/2013 None
N/A
N/A
SAN ANTONIO TX
FORT WORTH TX
ACTIVE
ACTIVE
4/27/2009 None
12/8/2011 None
N/A
N/A
FORT WORTH TX
ACTIVE
LICENSE
ISSUED
9/10/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
6/14/2011 None
N/A
ACTIVE
4/26/2010 None
N/A
PULMONARY
CRITICAL CARE
MEDICINE
LICENSE
ISSUED
PUBLIC
HEALTH/PREVENTIVE
MEDICINE (GENERAL)
EMERGENCY
MEDICINE
INTERNAL MEDICINE
SURGICAL
ONCOLOGY
ANESTHESIOLOGY
EMERGENCY
MEDICINE
OTOLARYNGOLOGY
ORTHOPEDIC
ARTHRITIS & JOINT
SURGERY
IMPLANT SURGERY
DALLAS
TX
DE ROSA, NICOLE, MD
DE SILVA, ANIL MOHAN, MD
5/15/2013
5/1/2013
5/15/2018
5/1/2018
N2055
P0970
DEAN, LARA , MD
DEAN, MARC RICHARD, MD
2/6/2009
9/15/2011
2/6/2014
9/15/2016
P7423
DEAN, THAD JAMES, DO
8/1/2013
8/1/2018
N6252
DEARING, PAUL DAVID, MD
6/4/2010
N9841
DEB, NILOYJYOTI, MD
DEBACKER, CHRISTOPHER
MACDONALD, MD
6/3/2011
RADIATION
6/3/2016 ONCOLOGY
OPHTHALMOLOGY 4/9/2015 RECONST SURGERY COSMETIC SURGERY SAN ANTONIO TX
Page 67 of 300
4/9/2010
Disciplinary
Status Date
PEDIATRICS
P6602
P6371
N5646
Registration
Status Date
Disciplinary
Status of
Texas
License
Practice City
CORPUS
CHRISTI
EMERGENCY
8/30/2018 MEDICINE
OBSTETRICS &
GYNECOLOGICAL
8/2/2015 SURGERY
INFECTIOUS
5/29/2014 DISEASES
Registration
Status of
Practice
Texas
State
License
License
Number
Physician Name
P0368
DEBELA, ZENEBE ASFAW, MD
N7789
DEBROY, ASHISH NARAYAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2011
PEDIATRIC
GASTROENTEROLOG
10/1/2010
10/1/2015 Y
P3141
DECKARD, NATHAN ALLEN, MD
5/15/2012
N6123
6/4/2010
N5009
DEES, CHARLES DONALD, MD
DEFRANCIS, JASON GREGORY,
MD
P4563
DEIPARINE, JULIUS F, MD
10/1/2012
10/1/2017 NEUROLOGY
P0369
DEL CRISTO, ROBERTO RAUL, MD
7/15/2011
N3004
5/29/2009
N5647
DEL RIO RODRIGUEZ, BETTY , MD
DELAUGHTER, JONETHAN PAUL,
DO
P2110
DELAUZ, CARIDAD MAYLIN, MD
2/10/2012
P1289
DELGADO, GUSTAVO ADOLFO, MD
11/4/2011
TM00360 DELGADO, RUBY, MD
2/5/2010
4/9/2010
6/4/2010
TX
ACTIVE
10/8/2010 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/16/2012 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
10/19/2012 None
N/A
HEREFORD
TX
ACTIVE
7/22/2011 None
N/A
EMERGENCY
4/9/2015 MEDICINE
PEDIATRICS,
HOUSTON
TX
ACTIVE
6/3/2009 None
N/A
DANVILLE
PA
ACTIVE
LICENSE
ISSUED
4/19/2010 None
N/A
2/10/2012 None
N/A
ACTIVE
LICENSE
ISSUED
11/10/2011 None
N/A
6/4/2010 None
N/A
1/23/2012 None
N/A
PEDIATRICS
DERMATOPATHOLOG
6/4/2015 Y
HEMATOLOGY/ONCOL
12/1/2016 OGY
OBSTETRICS AND
4/1/2018 GYNECOLOGY
OTOLARYN & FACIAL CRANIOFACIAL
SURGERY
DELUKIE, ALEIGHA ANN, DO
DELYRIA, PAUL , MD
DELYRIA, PAUL , MD
DELYRIA, PAUL , MD
N3609
DEMKE, JOSHUA CHARLES, MD
8/21/2009
P1464
DEMOLA, SARA MICHELLE, MD
11/15/2011
N6254
DENDULURI, SANDEEP, MD
6/4/2010
8/2/2010
HOUSTON
ACTIVE
P5960
P5059
P5059
P5059
DENIZ, SANDRA IVETTE, MD
Practice City
AUSTIN
TX
DELRIE, RONALD DWAYNE JR, MD
4/1/2013
12/17/2012
12/17/2012
12/17/2012
URGENT CARE
MEDICINE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/22/2011 None
N/A
NEURO-PHYSIOLOGY
(NEUROLOGY)
BEAUMONT
P1538
N7248
12/1/2011
EMERGENCY
6/4/2015 MEDICINE
ORTHOPEDIC
2/5/2015 SURGERY
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
Page 68 of 300
BRYAN
TX
DALLAS
TX
ACTIVE
TEMPLE
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
SULPHUR
SPRINGS
TX
ACTIVE
4/10/2013
12/24/2012
12/24/2012
12/24/2012
None
None
None
None
N/A
N/A
N/A
N/A
9/25/2009 None
N/A
11/15/2011 None
N/A
6/4/2010 None
N/A
8/5/2010 None
N/A
License
Number
F6568
Physician Name
DENNEY, TERESA SUSAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
8/26/2011
8/26/2016 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
MISSOULA
Registration
Status of
Practice
Texas
State
License
ACTIVE
9/6/2011 None
N/A
TX
ACTIVE
7/21/2011 None
N/A
TX
9/13/2010 None
N/A
7/1/2011 None
9/20/2010 None
N/A
N/A
8/1/2011 None
10/7/2009 None
N/A
N/A
8/27/2010
OBSTETRICS AND
7/1/2011
8/16/2010
INTERNAL MEDICINE WADSWORTH OH
8/1/2011
8/21/2009
P0035
DERDERIAN, CHRISTOPHER
ARMEN, MD
6/15/2011
CRANIOFACIAL
6/15/2016 SURGERY
P0371
DERESKA, NINA HOLTZAPPLE, MD
7/15/2011
N5013
DERESKA, PAUL STEPHEN , DO
P7267
DERMISH, AMNA IBRAHIM, MD
7/15/2013
L2364
N7078
DEROBERTIS, ANGELA, MD
DEROSA, CHAD ALEN, MD
4/9/2010
7/15/2010
N5649
P2431
P2432
DESAI, KUMAR SUBODH, MD
DESAI, MIT NAVANIT, MD
DESAI, RONAK KIRTI, MD
4/9/2010
3/15/2012
3/15/2012
P4435
DESAI, SONAL SUBODH, MD
9/17/2012
P1452
N1304
DESANTIS, JAMES MICHAEL, MD
DESCIOLI, KELLY RYANN, MD
N5014
DESENA, ALLEN DOUGLAS, MD
P5794
P6604
DESHMUKH, ANAND RAMESH, MD
DESHPANDE, ALOK , MD
DENNIS, ROBYN MONET, MD
7/15/2011
N7533
P0572
N3611
DENNIS, RONNIE WAYNE, MD
DENNISON, MATTHEW STEPHEN,
MD
DEO, DATINDER BIR SINGH, MD
DEO, SHEETAL RAMACHANDRA,
MD
DEPPISCH, HANNAH GRUBB, MD
P0194
N7413
2/5/2010
EMERGENCY
2/5/2015 MEDICINE
OBSTETRICS AND
RADIATION
4/9/2015 ONCOLOGY
7/15/2015 UROLOGY
GASTROENTEROLOG
4/9/2015 Y
PEDIATRIC
GASTROENTEROLOG
9/17/2017 Y
EMERGENCY
11/15/2016 MEDICINE
PEDIATRIC
2/5/2015 NEUROLOGY
3/15/2013
5/15/2013
2/5/2010
11/15/2011
10/10/2008
Disciplinary
Status Date
MT
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HOUSTON
SWEETWATE
R
P0370
Registration
Status Date
Disciplinary
Status of
Texas
License
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
PLASTIC &
RECONSTRUCTIVE
SURGERY
DALLAS
TX
ACTIVE
6/20/2011 None
N/A
UROGYNECOLOGY
WEBSTER
TX
ACTIVE
LICENSE
ISSUED
7/25/2011 None
N/A
2/5/2010 None
N/A
AUSTIN
TX
ACTIVE
7/26/2013 None
N/A
TEMPLE
EL PASO
TX
TX
ACTIVE
ACTIVE
4/14/2010 None
7/20/2010 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
4/29/2010 None
3/21/2012 None
3/26/2012 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
9/25/2012 None
N/A
11/15/2011 None
10/21/2008 None
N/A
N/A
2/5/2010 None
N/A
3/20/2013 None
5/27/2013 None
N/A
N/A
GASTROENTEROLOG
Y
SAN ANTONIO TX
PEDIATRICS
INTERVENTIONAL
CARDIOLOGY
Page 69 of 300
OMAHA
HOUSTON
NE
TX
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P0195
DESHPANDE, AVINASH SHRINIVAS,
MD
P0719
P2635
DESOUZA, ROWENA ANNE, MD
DESTA, DEREJE, MD
8/15/2011
4/2/2012
N9361
P6375
4/8/2011
5/1/2013
P6964
P5617
N9539
DETOLEDO, JOAO CARLOS, MD
DEVAGIRI, MADHAVI, MD
DEVANEY, RACHEL LEA ISRAEL,
MD
DEVIDOSS, SHARMILA , MD
DEVOE, JAMES FRAUSTO, MD
P4944
DEW, LAUREN ASHLEY, MD
P4642
DEWITT, ROBERT MICHAEL, MD
N9039
DEWITTE, DAVID M, MD
7/1/2011
6/14/2013
3/1/2013
5/2/2011
7/1/2016 PEDIATRICS
4/8/2016 NEUROLOGY
10/15/2012
3/1/2018 NEPHROLOGY
5/2/2016
OBSTETRICS AND
DIAGNOSTIC
3/15/2011
11/30/2012
P4749
DHANANI, NADEEM NIZAR, MD
11/1/2012
N8089
P2228
DHARAMSI, FARID , MD
DHARAMSI, JENNIFER WARNER,
MD
P5963
DHAWAN, MANISH, MD
P0373
P4436
DHAWAN, RICHA, MD
DHEER, SACHIN, MD
7/15/2011
9/17/2012
N7534
DHILLON, JASPINDER SINGH, MD
P1986
P7096
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
Practice City
PUNE,
MAHARASHTR
A
TX
KANSAS
KS
INTERVENTIONAL
CARDIOLOGY
TYLER
TX
INTERNAL MEDICINE
PAIN MANAGEMENT WEST PLAINS MO
DALLAS
TX
INTERVENTIONAL
RADIOLOGY
UROLOGIC
11/1/2017 UROLOGIC SURGERY ONCOLOGY
EMERGENCY
11/15/2015 MEDICINE
DERMATOLOGIC
SURGERY
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/8/2011 None
N/A
8/15/2011 None
4/13/2012 None
N/A
N/A
4/8/2011 None
5/3/2013 None
N/A
N/A
6/14/2013 None
4/22/2013 None
5/9/2011 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/14/2012 None
N/A
10/15/2012 None
N/A
3/15/2011 None
N/A
HOUSTON
TX
ACTIVE
11/28/2012 None
N/A
DALLAS
TX
ACTIVE
12/2/2010 None
N/A
DALLAS
TX
ACTIVE
3/8/2012 None
N/A
INTERNAL MEDICINE SHREVEPORT LA
ACTIVE
4/3/2013 None
N/A
9/17/2017 RADIOLOGY
RHEUMATOLOGY
RADIOLOGY
8/1/2011 None
9/24/2012 None
N/A
N/A
8/27/2010
GERIATRICS
8/27/2010 None
N/A
DHILLON, RENNEE NAGRA, MD
DHIR, ROHIT ROBERT, MD
2/1/2012
7/1/2013
2/1/2012 None
7/3/2013 None
N/A
N/A
P5171
DHOTRE, DHEERAJ, MD
1/4/2013
7/1/2018 UROLOGY
PULMONARY
CRITICAL CARE
1/4/2018 MEDICINE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
1/4/2013 None
N/A
P0196
DIAGNE, THIENDELLA, MD
7/1/2011
ACTIVE
8/3/2011 None
N/A
11/15/2010
3/1/2012
4/1/2013
4/1/2018 ONCOLOGY
SHREVEPORT LA
CHERRY HILL NJ
FAMILY PRACTICE
HOUSTON
INTERNAL MEDICINE
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
7/1/2016 GYNECOLOGY
SURGERY
EDINBURG
Page 70 of 300
TX
TX
License
Number
Physician Name
N9362
DIAL, DEANNA LEE, DO
P4565
N0731
DIAMOND, MICHAEL JEREMY, MD
DIAZ DE LEON, DAVID JR, MD
N1305
DIAZ SANTANA, PEDRO , MD
N9692
DIAZ, CHRISTOPHER DAVID, MD
P5355
P4750
DIAZ, JESUS RAFAEL, MD
DIAZ, KYLE IBANEZ, MD
P1290
DIAZ, LINA BOLANOS, MD
P5172
N0730
N9040
DIAZ, LUCIA ZORAIDA, MD
DIAZ, MARCO , MD
DIAZ, PAUL MICHAEL, MD
N9843
DIAZ, TULIO, MD
N8290
DIAZGRANADOS, NANCY, MD
P0823
P4860
DICE, DAVID LOUIS JR, MD
DICKERSON, JEREMY LEE, MD
P1746
N5651
DICKSON, DOUGLAS DARKO, MD
DICKSON, WESLEY ALLAN, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
4/8/2011
4/8/2016 PSYCHIATRY
PSYCHOANALYSIS
EMERGENCY
10/1/2012
MEDICINE
8/29/2008
INTERVENTIONAL
10/10/2008
CARDIOLOGY
EMERGENCY
5/16/2011
5/16/2016 MEDICINE
DIAGNOSTIC
2/1/2013
2/1/2018 RADIOLOGY
RADIOLOGY
11/1/2012
PEDIATRIC
ANESTHESIOLOGY
11/4/2011
(PEDS)
PEDIATRIC
1/4/2013
DERMATOLOGY
8/29/2008
3/15/2011
CARDIOVASCULAR
INTERVENTIONAL
6/3/2011
6/3/2016 DISEASES
CARDIOLOGY
PHARMACOLOGY,
12/15/2010
CLINICAL
ORTHOPEDIC
8/26/2011
8/26/2016 SURGERY
11/15/2012
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
1/2/2012
1/2/2017 SURGERY
SPINE
4/9/2010
CHILD AND
ADOLESCENT
6/4/2010
6/4/2015 PSYCHIATRY
CARDIOVASCULAR
1/4/2013
1/4/2018 DISEASES
8/16/2010
N6257
DIEDERICH, ANDREW DAVID, MD
P5173
N7416
DIESTEL, ECKHART, MD
DIGIORGIO, CATHERINE, MD
N5018
DILLON, BENJAMIN ETHAN, MD
2/5/2010
2/5/2015 UROLOGY
N6857
DILLON, JEFFREY DAVID, MD
7/1/2010
P1539
DILMAGHANIAN, OMID GILLANI, MD
12/1/2011
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
Practice City
DALLAS
CARRIZO
SPRINGS
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
10/3/2012 None
9/8/2008 None
N/A
N/A
LAREDO
TX
ACTIVE
11/7/2008 None
N/A
TYLER
TX
ACTIVE
6/15/2011 None
N/A
EL PASO
EL DORADO
TX
AR
ACTIVE
ACTIVE
2/28/2013 None
11/6/2012 None
N/A
N/A
ACTIVE
11/23/2011 None
N/A
EL PASO
TX
ACTIVE
ACTIVE
ACTIVE
1/14/2013 None
10/27/2008 None
3/18/2011 None
N/A
N/A
N/A
ARLINGTON
TX
ACTIVE
6/16/2011 None
N/A
SAN ANTONIO TX
ACTIVE
12/21/2010 None
N/A
TYLER
TX
ACTIVE
ACTIVE
9/2/2011 None
11/27/2012 None
N/A
N/A
TX
LICENSE
ISSUED
ACTIVE
1/2/2012 None
4/26/2010 None
N/A
N/A
6/4/2010 None
N/A
1/4/2013 None
8/25/2010 None
N/A
N/A
2/5/2010 None
N/A
7/1/2010 None
N/A
1/4/2012 None
N/A
DALLAS
WEBSTER
TX
UROLOGIC SURGERY
FAMILY MEDICINE
Page 71 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
4/13/2011 None
N/A
CHEYENNE
WY
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P0720
DIM, UZODINMA RAPHAEL, MD
8/15/2011
N3619
8/21/2009
P2851
P6605
DIMEFF, ROBERT JOSEPH, MD
DINARDO, COURTNEY DENTON,
MD
DING, KAN , MD
P2229
DING, LIN, DO
3/1/2012
N8642
DINKINS, RICHARD SCOTT, MD
2/4/2011
N1613
DIRNBERGER, DANIEL ROBERT,
MD
P6606
DITOMMASO, CRAIG , MD
5/15/2013
P3144
DIXIT, SANTOSH KUMAR, DO
5/15/2012
N5019
DIXON, JARED , MD
4/13/2012
5/15/2013
12/12/2008
2/5/2010
P7099
N5654
DIXON, TANYA STOYANOVA, DO
DO, DOAN THUY, MD
7/1/2013
4/9/2010
P0039
N3622
P2433
N3010
N9041
N9695
P1541
DO, KIM DAN, MD
DO, MICHAEL KIM, MD
DO, NHU QUYNH, MD
DO, THONG HUY, MD
DOAN, DENNIS PHUONG, MD
DOAN, ELLIS, MD
DOAN, JANIE THAO, MD
6/15/2011
8/21/2009
3/15/2012
5/29/2009
3/15/2011
5/16/2011
12/1/2011
P7268
P4753
DOBKIN, DEAN, MD
DODD, JAMES RUSSELL, MD
7/15/2013
11/1/2012
N9363
DODDABELE, SUDARSHAN R, MD
4/8/2011
N8643
DODLA, SARITHA, MD
2/4/2011
Secondary Specialty
(Self-Designated)
CARDIAC
ELECTROPHYSIOLO
GY
INTERVENTIONAL
SPORTS MEDICINE
FAMILY MEDICINE
HEMATOLOGY/ONCOL
4/13/2017 OGY
ONCOLOGY
5/15/2018 NEUROLOGY
EMERGENCY
3/1/2017 MEDICINE
EMERGENCY
MEDICINE
NEONATALPERINATAL
MEDICINE
PHYSICAL MED. &
EMERGENCY
5/15/2017 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
EL PASO
TX
DALLAS
TX
DALLAS
TX
FLUSHING
NY
Disciplinary
Status Date
8/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
8/26/2009 None
N/A
4/13/2012 None
5/23/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
3/23/2012 None
N/A
2/4/2011 None
N/A
LACKLAND
AFB
TX
ACTIVE
12/29/2008 None
N/A
HOUSTON
TX
ACTIVE
6/3/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
5/21/2012 None
N/A
2/5/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
8/23/2013 None
4/28/2010 None
N/A
N/A
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/20/2011
11/12/2009
3/19/2012
7/20/2009
3/28/2011
5/19/2011
12/6/2011
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
PA
ACTIVE
ACTIVE
7/18/2013 None
11/16/2012 None
N/A
N/A
IA
ACTIVE
4/18/2011 None
N/A
2/4/2011 None
N/A
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
NEUROLOGICAL
7/1/2018 SURGERY
FORT WORTH
HOUSTON
PHYSICAL MED. &
DALLAS
8/21/2014 RADIOLOGY
TEMPLE
SPRING
INTERNAL MEDICINE
AUSTIN
HOUSTON
EMERGENCY
7/15/2018 MEDICINE
PHILADELPHIA
HEMATOLOGY/ONCOL
4/8/2016 OGY
INTERNAL MEDICINE SIOUX CITY
GERIATRIC
MEDICINE (INTERNAL
2/4/2016 CARDIOLOGY
MED)
Page 72 of 300
TX
TX
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ANGIOGRAPHY &
INTERVENTIONAL
DIAGNOSTIC
3/1/2012
3/1/2017 RADIOLOGY
RADIOLOGY
P2230
DOE, ANDREW LAWRENCE, MD
N7079
P2980
N1614
DOE, JAMES YAO, MD
DOE, JENNIFER WEN, MD
DOLLINS, KATHLEEN BOYD, MD
P4437
DOLZ, MARK STEPHEN, DO
N9364
P5269
DOMBROSKI, DEREK GEORGE, MD
DOMINGUEZ VALLEJOS, LUIS
AUGUSTO, MD
P5968
DOMINGUEZ, AURORA, MD
N9696
DOMINGUEZ, DAVID EMILIO, MD
5/16/2011
OBSTETRICS AND
4/1/2018 GYNECOLOGY
ORTHOPEDIC
5/16/2016 SURGERY
N6262
6/4/2010
P0375
DOMINGUEZ, MANUEL , MD
DOMMARAJU, SUBHA RAJITHA ,
MD
N5657
DONDAPATI, CHANDRA MALINI, DO
4/9/2010
P5969
DONELSON, JULIA ANNE, MD
4/1/2013
P0040
N9042
DONOHUE, THOMAS A, MD
DOPKE, CHERYL ANNE, DO
N2473
DOPPALAPUDI, HIMA SUDHA, MD
4/3/2009
N6265
DOROFTEI, OLGA, MD
6/4/2010
CARDIOVASCULAR
6/15/2016 SURGERY
PAIN
MANAGEMENT/REHAB
4/3/2014 MED
PHYSICAL MED. &
7/15/2010
5/1/2012
12/12/2008
9/17/2012
4/8/2011
1/15/2013
4/1/2013
7/15/2011
6/15/2011
3/15/2011
5/1/2017 RADIOLOGY
ANATOMIC/CLINICAL
9/17/2017 PATHOLOGY
ORTHOPEDIC
4/8/2016 TRAUMA
DOROSTKAR, PARVIN C, MD
5/29/2009
P4438
DORTILUS, JEAN NERVA, MD
DOSADO, JOSE MARIUS DEDEL,
MD
9/17/2012
N7250
8/2/2010
UNION
NJ
BREAST IMAGING
MONTCLAIR
MCKINNEY
CYTOPATHOLOGY
ORTHOPEDIC
SURGERY
N/A
NJ
TX
7/15/2010 None
5/18/2012 None
1/28/2009 None
N/A
N/A
N/A
MEMPHIS
TN
ACTIVE
9/27/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/2/2011 None
N/A
1/15/2013 None
N/A
4/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
5/31/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
8/8/2011 None
N/A
4/9/2010 None
N/A
4/1/2013 None
N/A
6/15/2011 None
4/1/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
6/29/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
6/17/2009 None
N/A
ACTIVE
10/18/2012 None
N/A
ACTIVE
8/23/2010 None
N/A
TX
TX
FORT WORTH TX
DALLAS
TX
PEDIATRIC CRITICAL
CARE MEDICINE
MINNEAPOLIS MN
CHILD AND
ADOLESCENT
PSYCHIATRY
SIOUX FALLS
Page 73 of 300
Disciplinary
Status Date
3/26/2012 None
SUGAR LAND
8/2/2015
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
NEPHROLOGY
N3011
Practice City
Registration
Status of
Practice
Texas
State
License
SD
License
Number
N1307
Physician Name
DOSHI, PRATIK BHARATKUMAR,
MD
N8644
DOSS, JOHN RICHARD, MD
P5796
DOUGHERTY, ALEXIS LEAH, MD
DOUGLAS-ESCOBAR, MARTHA
VICTORIA , MD
DOWDELL-SMITH, CICELY
PATRICE, MD
N3012
P6607
N6268
DOWNIE, BENJAMIN JOEL, MD
N9846
N8090
DOYLE, NORA MARY, MD
DRAGHINAS, DAVID, MD
N2474
P7269
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
CRITICAL CARE 10/10/2008
10/10/2013 MEDICINE
NEUROSURGERY
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
2/4/2011
2/4/2016 GYNECOLOGY
SURGERY
DERMATOLOGIC
3/15/2013
SURGERY
5/29/2009
5/15/2013
6/4/2010
PEDIATRIC
5/15/2018 NEUROLOGY
6/3/2011
11/15/2010
6/4/2015 ONCOLOGY
OBSTETRICS &
GYNECOLOGICAL
6/3/2016 SURGERY
DRAWERT, CASEY MITCHELL, MD
DREISS, WILLIAM , MD
4/3/2009
7/15/2013
N6269
DRENNAN, EMILY LORRAINE, MD
6/4/2010
N2476
P7270
DREVER, NATHAN SCOTT, MD
DRIMER-KAGAN, TALY , MD
4/3/2009
7/15/2013
OBSTETRICS AND
4/3/2014 GYNECOLOGY
N8638
P6808
N3014
D'SOUZA, SWATI FRANCISCA, MD
DU, YE BEVERLY, MD
DUBIN, JOSEPH ETHAN, MD
2/4/2011
6/3/2013
5/29/2009
N9697
DUBOIS, DALE DAVID, MD
5/16/2011
P5356
N8091
DUBOIS, JEFFERY COLEMAN, MD
DUEWALL, JENNY , MD
2/1/2013
11/15/2010
P1292
DUFFY, THARREN CHARLES, DO
11/4/2011
P5618
DUFRESNE, GARY WILLIAM, DO
3/1/2013
P2111
DUGGIRALA, RAVI KUMAR, MD
2/10/2012
6/3/2018 PSYCHIATRY
PEDIATRIC
EMERGENCY
Practice City
Registration
Status of
Practice
Texas
State
License
CRITICAL CARE
ANESTHESIOLOGY
PALLIATIVE
MEDICINE
MATERNAL AND
FETAL MEDICINE
TX
ACTIVE
1/13/2009 None
N/A
HOPE
SANTA
BARBARA
AR
ACTIVE
2/9/2011 None
N/A
CA
ACTIVE
3/21/2013 None
N/A
HOUSTON
TX
ACTIVE
6/15/2009 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
5/17/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
6/13/2011 None
12/7/2010 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/8/2009 None
7/19/2013 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
4/22/2009 None
7/26/2013 None
N/A
N/A
2/4/2011 None
6/5/2013 None
6/3/2009 None
N/A
N/A
N/A
SAN ANTONIO TX
ACTIVE
5/24/2011 None
N/A
BIRMINGHAM
AL
ACTIVE
ACTIVE
2/7/2013 None
11/18/2010 None
N/A
N/A
GRAND BLANC MI
ACTIVE
12/13/2011 None
N/A
SAN ANTONIO TX
CLEARWATER
,
FL
ACTIVE
3/4/2013 None
N/A
ACTIVE
2/20/2012 None
N/A
TULSA
DALLAS
OK
TX
SAN ANTONIO TX
TYLER
TX
GALVESTON
DALLAS
TX
TX
HOUSTON
HOUSTON
TX
TX
HOSPITALIST
EMERGENCY
11/4/2016 MEDICINE
EMERGENCY
3/1/2018 MEDICINE
Page 74 of 300
Disciplinary
Status Date
HOUSTON
HEMATOLOGY INTERNAL MEDICINE
MATERNAL AND
FETAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
NEUROLOGICAL
11/6/2009
11/6/2014 SURGERY
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
ORTHOPEDIC
ORTHOPEDIC
4/9/2010
4/9/2015 SURGERY
TRAUMA
DERMATOPATHOLO
11/6/2009
11/6/2014 PATHOLOGY
GY
N4387
DUHON, BRADLEY STUART, MD
H2349
DUKE, SHARON NELSON, DO
N5661
DUMAIS, JULES ARTHUR, MD
N4389
L7362
DUMAS, ALAIN , MD
DUMITRASCU, GEORGE
ALEXANDRU, MD
P0377
DUMLAO, DONATO GAERLAN, MD
N9847
DUNCAN, BRANNON CHARLES, MD
N7417
DUNCAN, CORY EVAN, MD
8/16/2010
P0041
DUNCAN, YANA, DO
6/15/2011
11/30/2012
7/15/2011
6/3/2011
P6156
DUNHAM, JEAN ANDERSON, MD
4/12/2013
N7080
DUNNIGAN, ERIN ELIZABETH, MD
7/15/2010
G9735
10/1/2012
N8183
DUNPHY, CHERIE HILBORN, MD
DUNTSCH, CHRISTOPHER DANIEL,
MD
N6270
P0721
DUONG, CHUONG, DO
DUONG, HUYEN VU, MD
6/4/2010
8/15/2011
J4094
K7012
N8908
DUONG, PAUL LIEM, MD
DUONG, ROBERT TRIEU, MD
DUPERVAL-BROWNLEE,
TAMARAH, MD
P6609
DURAINI, MAZEN , MD
P1177
DURAND SANCHEZ, ANA V, MD
12/1/2010
3/1/2012
7/1/2011
3/1/2011
5/15/2013
10/17/2011
7/15/2016 PALLIATIVE MEDICINE INTERNAL MEDICINE
EMERGENCY
6/3/2016 MEDICINE
EMERGENCY
8/16/2015 MEDICINE
EMERGENCY
6/15/2016 MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
ENDOCRINOLOGY,
DIABETES AND
INTERNAL MEDICINE
ANATOMIC/CLINICAL HEMATOLOGY
10/1/2017 PATHOLOGY
(PATHOLOGY)
NEUROLOGICAL
12/1/2015 SURGERY
EMERGENCY
6/4/2015 MEDICINE
FAMILY MEDICINE
RADIATION
3/1/2017 ONCOLOGY
7/1/2016 RADIOLOGY
NEURO-RADIOLOGY
ORAL &
MAXILLOFACIAL
5/15/2018 SURGERY
PHYSICAL MED. &
Page 75 of 300
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/6/2009 None
N/A
SNEEDVILLE
TN
ACTIVE
11/16/2009 None
N/A
LUBBOCK
TX
ACTIVE
4/26/2010 None
N/A
SHELTON
OTTAWA,
ONTARIO
CT
ACTIVE
11/17/2009 None
N/A
ACTIVE
12/4/2012 None
N/A
KINGWOOD
TX
ACTIVE
7/21/2011 None
N/A
AUSTIN
TX
ACTIVE
6/17/2011 None
N/A
ARLINGTON
TX
ACTIVE
LICENSE
ISSUED
8/23/2010 None
N/A
6/15/2011 None
N/A
4/12/2013 None
N/A
AUSTIN
tx
LICENSE
ISSUED
DALLAS
TX
ACTIVE
7/21/2010 None
N/A
DURHAM
NC
ACTIVE
10/3/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
12/9/2010 None
N/A
6/4/2010 None
8/19/2011 None
N/A
N/A
LOS
ALAMITOS
TAMPA
CA
FL
ACTIVE
ACTIVE
3/12/2012 None
7/7/2011 None
N/A
N/A
AUSTIN
TX
ACTIVE
3/23/2011 None
N/A
IRVING
TX
ACTIVE
LICENSE
ISSUED
5/31/2013 None
N/A
10/17/2011 None
N/A
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
DURET-UZODINMA, JENNY JEANOBSTETRICS AND
N5026
JULIEN, MD
2/5/2010
2/5/2015 GYNECOLOGY
N4390
DURHAM, MEGAN RAE, MD
11/6/2009
ENDOCRINOLOGY,
DURODOYE, OLUYEMISI MODINAT,
DIABETES AND
N9044
MD
3/15/2011
INTERNAL MEDICINE
DURRANT, AUDREY CARMELITA,
P5970
MD
4/1/2013
4/1/2018 PEDIATRIC SURGERY GENERAL SURGERY
OBSTETRICS AND
MATERNAL AND
P7103
DUTTA, ERYN HART, DO
7/1/2013
7/1/2018 GYNECOLOGY
FETAL MEDICINE
N7081
DUTTA, PUJA MANOJIT, MD
7/15/2010
N9848
DUVAL, TARA MICHELLE, MD
6/3/2011
P3526
DUVALL, DAVID BURL, MD
6/8/2012
DUVALL, LUCAS MAIER, MD
DUVIC, MARGARET DENISE, DO
4/12/2013
9/1/2011
9/1/2016 PEDIATRICS
P3527
N3624
DVORAK, DERRICK WILLIAM, MD
DWIBHASHI, VIJAYA L , MD
6/8/2012
8/21/2009
N5662
DWYER, MATTHEW MICHAEL, MD
4/9/2010
P7429
DWYER, PAUL RICHARD, MD
8/1/2013
N3625
P1294
N3017
DY, ROCHELLE COLEEN TAN , MD
DYER, CHRISTOPHER ANTHONY,
MD
DYKOSKI, LAURIE NIX, MD
ORTHOPEDIC
4/9/2015 SURGERY
EMERGENCY
8/1/2018 MEDICINE
PEDIATRIC
REHABILITATION
8/21/2014 MEDICINE
N2480
DYMOTT, JEAN ANN, MD
P4754
EAGLETON, KWAME , MD
EBERT-BLACKBURN, DIDI ELISE,
DO
N5513
P1988
N8909
EBRAHEEM, MOHAMMAD, MD
EBRAHIM, ELLAHEH , MD
N7695
EBUH, VALENTINE MBEPSON, MD
11/4/2011
5/29/2009
4/3/2009
EMERGENCY
4/3/2014 MEDICINE
11/1/2012
4/9/2010
2/1/2012
3/1/2011
9/15/2010
2/1/2017 PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
12/15/2009 None
N/A
N/A
LICENSE
ISSUED
3/15/2011 None
N/A
SAN ANTONIO TX
ACTIVE
4/11/2013 None
N/A
GALVEVSTON TX
HOUSTON
TX
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/9/2013 None
7/19/2010 None
6/20/2011 None
N/A
N/A
N/A
6/8/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
4/24/2013 None
11/3/2011 None
N/A
N/A
6/8/2012 None
9/21/2009 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
4/21/2010 None
N/A
WYOMING
MI
ACTIVE
8/12/2013 None
N/A
HOUSTON
TX
ACTIVE
8/25/2009 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
12/20/2011 None
6/9/2009 None
N/A
N/A
4/9/2009 None
N/A
11/1/2012 None
N/A
4/14/2010 None
N/A
2/1/2012 None
3/25/2011 None
N/A
N/A
9/15/2010 None
N/A
DALLAS
P6157
P0900
8/21/2009
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
CARDIOVASCULAR
SURGERY
SHREVEPORT LA
SAN ANTONIO TX
EMERGENCY
MEDICINE
HOUSTON
DALLAS
WACO
PEDIATRIC CRITICAL
CARE MEDICINE
OBSTETRICS
Page 76 of 300
TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
GASTROENTEROLOG
P1989
ECHARTEA GONZALEZ, JAIME, MD
2/1/2012
2/1/2017 Y
PEDIATRICS
ECHAVEZ-ARROYO, MARIA
N7251
SUSANA, MD
8/2/2010
N9448
N5028
ECKHART, RODGERS LONG, MD
EDDLEMAN, CHRISTOPHER SEAN,
MD
4/15/2011
2/5/2010
EDGELL, RANDALL CLIVE, MD
1/4/2013
1/4/2018 NEUROLOGY
P5357
EDSON, EMMANUEL, MD
2/1/2013
N6275
P5971
EDWARDS, IVAN , DO
EDWARDS, JEFFERY D, MD
6/4/2010
4/1/2013
N9046
EDWARDS, KENNY, MD
3/15/2011
P7761
EDWARDS, NANCY JEAN, MD
8/30/2013
8/30/2018 NEUROLOGY
P1637
EGBORGE, ESEOVHE ALALIBO, MD
P3315
EGELAND, BRENT M, MD
6/1/2012
N5030
EGELSEE, LUIS JR, MD
2/5/2010
12/15/2011
P6381
EGGLESTON, JOHN MORTON III,
MD
5/1/2013
N6276
EGLY, JOSHUA ALEXANDER, MD
6/4/2010
N5031
EGU, OBILOH ENYINNAYA , MD
2/5/2010
P6610
EHLERS, KARA A, MD
5/15/2013
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
HOUSTON
PHYSICAL MED. &
ORTHOPEDIC
3/15/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
6/1/2017 SURGERY
CINCINNATI
OH
OPHTHALMOLOGY ANTERIOR SURGERY
NEUROLOGICAL
2/5/2015 SURGERY
P5174
Practice City
Registration
Status of
Practice
Texas
State
License
TX
PAIN
MANAGEMENT/REHA
B MED
ORTHOPEDIC
SURGERY OF THE
SPINE
2/3/2012 None
N/A
8/2/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/28/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
2/21/2013 None
N/A
2/1/2013 None
N/A
6/4/2010 None
4/9/2013 None
N/A
N/A
TX
PLANO
TX
ACTIVE
3/18/2011 None
N/A
HOUSTON
TX
ACTIVE
9/5/2013 None
N/A
ACTIVE
12/20/2011 None
N/A
6/1/2012 None
N/A
2/5/2010 None
N/A
5/7/2013 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
5/27/2013 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
AUSTIN
DALLAS
Page 77 of 300
ACTIVE
LICENSE
ISSUED
DALLAS
5/1/2018 MICROSURGERY
EMERGENCY
6/4/2015 MEDICINE
OBSTETRICS AND
2/5/2015 GYNECOLOGY
OBSTETRICS AND
Disciplinary
Status Date
LICENSE
ISSUED
ACTIVE
PLASTIC &
RECONSTRUCTIVE
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
N8645
EISENBERG, LAUREN N, DO
EISENBERG, STEVEN BERNARD,
G3324
MD
dicaid
dicaid
Agreement
End Date
Designated)
2/4/2011
2/4/2016 UROLOGY
CARDIOVASCULAR
8/2/2010
8/2/2015 SURGERY
EMERGENCY
1/4/2013
1/4/2018 MEDICINE
4/9/2010
P5176
N5664
EITTER, PATRICK THOMAS, MD
EJERE, HENRY OMOIKHUDU, MD
N5665
EKERUO, WESLEY , MD
N4392
EKONG, ANTHONY SEBASTIAN, MD
11/6/2009
P2982
P3146
EKPENYONG, UDEME ISIDORE, MD
EL AHDAB, SAMIH , MD
5/1/2012
5/15/2012
P2435
EL ANNAN, JAAFAR FADL, MD
3/15/2012
N7919
EL FAKIH, RIAD OMAR, MD
N6862
EL KHOURY, RAMY , MD
N9699
EL MARAGHY, HALA RAAFAT, MD
P1178
EL TAL, ABDEL KADER , MD
P2639
ELAMIR, HANNAH SAFIA, DO
P0045
EL-ATFY, ASSER, MD
P0578
EL-BAGHDADI, MARIAM MAHDI, MD
N1314
ELHAMMADY, ESLAM , MD
N6279
ELIKAN, LAWRENCE , MD
6/4/2010
N6280
ELINE, MARY JO, DO
6/4/2010
6/4/2015 RADIOLOGY
4/9/2010
10/15/2010
7/1/2010
5/16/2011
10/17/2011
4/2/2012
6/15/2011
8/1/2011
10/10/2008
P7430
ELIZARRARAS, HERIBERTO , MD
8/1/2013
P5620
ELJAMMAL, SAM, MD
3/1/2013
Secondary Specialty
(Self-Designated)
Practice City
EL PASO
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
THORACIC SURGERY HOUSTON
TX
AEROSPACE
MEDICINE
SAN ANTONIO TX
HOSPITALIST
ALBANY
GA
8/5/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
1/15/2013 None
4/26/2010 None
N/A
N/A
4/9/2010 None
N/A
ACTIVE
1/13/2010 None
N/A
AL
ACTIVE
ACTIVE
5/7/2012 None
5/17/2012 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
3/19/2012 None
N/A
10/15/2010 None
N/A
7/1/2010 None
N/A
5/16/2011 None
N/A
SPRINGFIELD IL
5/1/2017 PEDIATRICS
MOBILE
OPHTHALMOLOGY 3/15/2017 VITREOUS SURGERY OPHTHALMOLOGY
HOUSTON
HEMATOLOGY/ONCOL
10/15/2015 OGY
INTERNAL MEDICINE
VASCULAR
7/1/2015 NEUROLOGY
NEUROLOGY
DERMATOLOGIC
10/17/2016 SURGERY
DIAGNOSTIC
4/2/2017 RADIOLOGY
PULMONARY
CRITICAL CARE
6/15/2016 MEDICINE
DERMATOLOGY
OBSTETRICS AND
PULMONARY
CRITICAL CARE
3/1/2018 MEDICINE
SLEEP MEDICINE
OBSTETRICS AND
GYNECOLOGY
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
2/14/2011 None
N/A
DEARBORN
MI
ACTIVE
10/18/2011 None
N/A
HOUSTON
TX
ACTIVE
4/4/2012 None
N/A
LICENSE
ISSUED
6/15/2011 None
N/A
ACTIVE
8/11/2011 None
N/A
10/29/2008 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
8/1/2013 None
N/A
3/7/2013 None
N/A
COLUMBUS
TX
EMERGENCY
MEDICINE
INTERNAL MEDICINE LOS ANGELES CA
Page 78 of 300
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5271
EL-KASS, GABRIEL, MD
1/15/2013
P1069
N9542
P6612
N7419
ELLENBECKER, BEAU JAMES, DO
ELLENDULA, SWATI, MD
ELLENT, LIBBY, MD
ELLIS, ANDREA MARIE, MD
10/3/2011
5/2/2011
5/15/2013
8/16/2010
10/3/2016
5/2/2016
5/15/2018
8/16/2015
N4395
ELLIS, PATRICK ANDREWS, MD
11/6/2009
P7431
ELLIS, STEVEN LEE, DO
N9048
ELLIS, THOMAS WALLACE, MD
8/1/2013
3/15/2011
FAMILY MEDICINE
PSYCHIATRY
INTERNAL MEDICINE
FAMILY MEDICINE
OBSTETRICS AND
EMERGENCY
8/1/2018 MEDICINE
EMERGENCY
3/15/2016 MEDICINE
P7105
P5800
ELLISON, JEFFREY COWAN, MD
ELLISON, KEITH TAYLOR, MD
7/1/2013
3/15/2013
J1985
ELLSTROM, STEVEN JORDAN, MD
6/3/2013
N3631
ELMAHI, NADEAR ABDURAHMAN
GORASHI , MD
8/21/2009
P4568
ELMAZI, FUNDIME , DO
10/1/2012
OBSTETRICS AND
P1297
P6160
P7104
ELMHISHI, OSAMA MOHAMED, MD
ELNEMR, MINA , MD
EL-QADDOUMI, HIBA F, MD
11/4/2011
4/12/2013
7/1/2013
N4397
N3632
ELRAIE, KHALED FOUAD, MD
ELSAID, SALEH , MD
11/6/2009
8/21/2009
N8910
N3633
ELSAID, SAMEH FOUAD, MD
ELSANJAK, ABDELAZIZ ALI, MD
3/1/2011
8/21/2009
P0046
ELUEZE, IFEANYI EMMANUEL, MD
6/15/2011
N6282
ELWELL, DANIEL MARK, DO
N0749
EMEJUAIWE, NKECHINYERE , MD
6/4/2010
8/29/2008
Secondary Specialty
(Self-Designated)
Practice City
GERIATRIC
MEDICINE (INTERNAL
MED)
BROOKLYN
APO
VICKSBURG
AE
MS
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/31/2011
5/9/2011
5/29/2013
8/23/2010
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
11/16/2009 None
N/A
ACTIVE
8/6/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
3/18/2011 None
N/A
7/1/2013 None
4/11/2013 None
N/A
N/A
ACTIVE
DELINQUEN
T-NON
PAYMENT
6/11/2013 None
N/A
INTERNAL MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
AUSTIN
11/19/2009 None
N/A
IOWA CITY
HOUSTON
MIDLAND
EMERGENCY
6/4/2015 MEDICINE
NY
1/23/2013 None
Disciplinary
Status Date
ACTIVE
GASTROENTEROLOG
Y
BROOKLYN
Registration
Status Date
Disciplinary
Status of
Texas
License
NY
EL PASO
TX
THE
WOODLANDS TX
11/4/2016 INTERNAL MEDICINE INTERNAL MEDICINE
GASTROENTEROLOG
11/6/2014 Y
FAMILY MEDICINE
INFECTIOUS
3/1/2016 INTERNAL MEDICINE DISEASES
Registration
Status of
Practice
Texas
State
License
N/A
TX
ACTIVE
10/8/2012 None
N/A
IA
TX
TX
11/8/2011 None
4/22/2013 None
7/3/2013 None
N/A
N/A
N/A
11/6/2009 None
10/14/2009 None
N/A
N/A
GALVESTON
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TROY
DANVILLE
NC
VA
ACTIVE
ACTIVE
3/28/2011 None
9/1/2009 None
N/A
N/A
LONGVIEW
TX
ACTIVE
LICENSE
ISSUED
6/21/2011 None
N/A
6/4/2010 None
N/A
10/28/2008 None
N/A
INTERNAL MEDICINE SUGAR LAND
Page 79 of 300
TX
ACTIVE
License
Number
Physician Name
N5669
N3021
P1639
EMERICK, ROBERT SCOTT, MD
EMERICK, SCOTT, MD
EMORY, RONYA LASHELLE, MD
N5037
ENCARNACION, ELMYRA V., MD
ENCARNACION, ORLANDO JOSE,
MD
N5038
P1748
P1992
P0202
N6863
P6613
ENG, DAVID ROBERT, MD
ENG, KRISTINA MARIE-MARTEL,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
INTERVENTIONAL
4/9/2010
4/9/2015 CARDIOLOGY
CARDIOLOGY
5/29/2009
12/15/2011
MOVEMENT
2/5/2010
2/5/2015 NEUROLOGY
DISORDERS
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
CARDIOTHORACIC
1/2/2012
ANESTHESIOLOGY
CARDIOTHORACIC
2/1/2012
ANESTHESIOLOGY
CARDIOVASCULAR
7/1/2011
7/1/2016 DISEASES
INTERNAL MEDICINE
7/1/2010
5/15/2013
PEDIATRICS,
3/1/2013
3/1/2018 CARDIOLOGY
PEDIATRICS
GASTROENTEROLOG
7/1/2010
7/1/2015 INTERNAL MEDICINE Y
OBSTETRICS AND
3/1/2011
3/1/2016 GYNECOLOGY
P5622
ENG, MARVIN HO-KEUNG, MD
ENGEL, DELPHINE , MD
ENGELHARDT, CANDACE, MD
ENGELHARDT, KEVIN PATRICK,
MD
N6864
ENGELKING, LUKE JAMES, MD
N8911
ENGGANO, BRIAN MATTHEW, MD
N8506
N8291
P0047
P4947
ENGLE, MITCHELL PHILIP, MD
ENGLISH, DUSTIN LEE, MD
ENTRIKEN, WILLIAM FRANCIS JR,
DO
ENWEMNWA, NNEAMAKA, MD
P2232
EPPEL, KONRAD JOSEPH, MD
N9449
EPPLER, MAIA FIODOR, MD
4/15/2011
P0203
EPPS, WILLIAM JAMES, MD
7/1/2011
N0751
ERANI, DAVID MICHAEL, MD
8/29/2008
P1455
ERWIN, JAMIE LIN WALKER, MD
P2233
ESCALANTE, THERESA JEAN, MD
1/18/2011
12/15/2010
6/15/2011
11/30/2012
3/1/2012
11/15/2011
3/1/2012
EMERGENCY
6/15/2016 MEDICINE
EMERGENCY
3/1/2017 MEDICINE
8/29/2013 DIABETES
OBSTETRICS AND
Practice City
PINEVILLE
GARLAND
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
KY
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
N/A
N/A
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
1/9/2012 None
N/A
2/1/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
8/9/2011 None
7/12/2010 None
5/22/2013 None
N/A
N/A
N/A
3/1/2013 None
N/A
TX
ACTIVE
7/14/2010 None
N/A
3/14/2011 None
N/A
AL
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
1/18/2011 None
12/27/2010 None
N/A
N/A
6/15/2011 None
12/11/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/28/2012 None
N/A
4/15/2011 None
N/A
7/1/2011 None
N/A
ACTIVE
9/12/2008 None
N/A
ACTIVE
11/18/2011 None
N/A
ACTIVE
4/10/2012 None
N/A
SAN ANTONIO TX
LUBBOCK
TX
FORT WORTH TX
PAIN MEDICINE
BIRMINGHAM
EMERGENCY
MEDICINE
PEDIATRICS
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
Page 80 of 300
KLAMATH
FALLS
HOUSTON
KERRVILLE
Disciplinary
Status Date
4/9/2010 None
6/4/2009 None
1/5/2012 None
SAN ANTONIO TX
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
OR
TX
TX
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
N4401
Physician Name
ESCALONA-CRUZ, RELPHA
VAGILIDAD , MD
P1994
ESCANDON, JOSE AMBROSIO, MD
2/1/2012
HARLINGEN
TX
ACTIVE
2/3/2012 None
N/A
P1749
1/2/2012
BRYAN
TX
ACTIVE
1/17/2012 None
N/A
P4863
N8393
ESCHBERGER, ANNE MARIE , MD
ESCOBAR CAMARGO, JORGE
MARIO, MD
ESCOBAR, ENRIQUE DIEGO, MD
11/15/2012
1/3/2011
CARDIOLOGY
HOUSTON
DALLAS
TX
TX
12/24/2012 None
1/10/2011 None
N/A
N/A
N5042
ESCOBAR, JORGE JAVIER JR, MD
2/5/2010
OBSTETRICS
2/5/2010 None
N/A
P7106
ESCORCIA, EDUARDO , MD
7/1/2013
N3637
P6161
P6811
N7253
N8394
P6966
ESCOTT, MARK EDWARD , MD
ESCOVAR, EKTA SAHEBA, MD
ESCOVAR, RAPHAEL, MD
ESIELY, MOHAMED ABDELHADY,
MD
ESPADA, YAHAIRA, MD
ESPARZA, LUIS MIGUEL, MD
8/2/2010
1/3/2011
6/14/2013
EMERGENCY
8/21/2014 MEDICINE
OBSTETRICS AND
8/2/2015 GYNECOLOGY
1/3/2016 PSYCHIATRY
ACTIVE
ACTIVE
LICENSE
ISSUED
N6284
ESPINOZA, ERICA RUIZ, MD
6/4/2010
N0752
ESPINOZA, MANUEL GEORGE, MD
ESPINOZA-ERVIN, CHRISTOPHER,
MD
P2983
P0206
11/6/2009
8/21/2009
4/12/2013
6/3/2013
8/29/2008
5/1/2012
P1860
ESQUILIN, JOSE MANUEL, MD
ESQUIVEL-VANEGAS, GERMAN
ROMAN, MD
7/1/2011
1/17/2012
N7793
ESSANDOH, YVONNE ARABA, DO
10/1/2010
P4864
ESSANI, RAHILA, MD
N5671
ESTRADA, CHRISTOPHER RAY, MD
N0753
P5623
ESTRADA, MANUEL ARTURO, MD
ESUZOR, LINDA CHIBUZOR, MD
11/15/2012
4/9/2010
8/29/2008
3/1/2013
ANESTHESIOLOGY
EMERGENCY
MEDICAL SERVICES
Practice City
JACKSONVILL
E
TX
ACTIVE
11/17/2009 None
N/A
AUSTELL
GA
ACTIVE
8/19/2013 None
N/A
HERSHEY
PA
ALPINE
TX
ACTIVE
ACTIVE
ACTIVE
11/20/2009 None
4/17/2013 None
6/5/2013 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
9/22/2010 None
1/24/2011 None
6/18/2013 None
N/A
N/A
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/8/2008 None
N/A
5/1/2012 None
N/A
LUBBOCK
TX
ORTHOPEDIC
5/1/2017 SURGERY
PEDIATRIC
HEMATOLOGY/ONCOL
7/1/2016 OGY
HARLINGEN
CORPUS
CHRISTI
TX
ACTIVE
7/11/2011 None
N/A
MCALLEN
TX
ACTIVE
1/23/2012 None
N/A
ACTIVE
10/6/2010 None
N/A
TX
ACTIVE
12/3/2012 None
N/A
TX
ACTIVE
5/3/2010 None
N/A
ODESSA
TX
Page 81 of 300
ACTIVE
ACTIVE
9/30/2008 None
3/25/2013 None
N/A
N/A
COLON AND RECTAL
11/15/2017 SURGERY
GENERAL SURGERY TEMPLE
PEDIATRIC ANES
(PEDS)
HOUSTON
TX
License
Number
Physician Name
P5973
ETEMADI, ALIREZA, MD
N1626
P2438
N7254
N4403
P1070
ETIENNE, ABDIAS DEMETREE, MD
ETOKHANA, KENNETH
OSHIOKHAYAMHE, MD
EUBANK, KATHRYN JEAN, MD
EVANGELISTA, MONALIZA
SANTOS, MD
P5625
EVANS, AMANDA SUAREZ, MD
EVERETT, JENNIFER MICHELLE,
DO
P7107
EVERETT, JEREMY CHAD, DO
P2641
dicaid
dicaid
Agreement
End Date
Designated)
4/1/2013
12/12/2008
3/15/2012
8/2/2010
Practice City
ALISO VIEJO
Registration
Status of
Practice
Texas
State
License
CA
ACTIVE
EDINBURG
TX
ACTIVE
3/2/2009 None
N/A
BRONX
NY
ACTIVE
3/21/2012 None
N/A
TX
ACTIVE
8/12/2010 None
N/A
ACTIVE
12/28/2009 None
N/A
ACTIVE
11/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/22/2013 None
N/A
7/1/2013 None
N/A
4/2/2012 None
N/A
MS
ACTIVE
9/22/2008 None
N/A
PA
ACTIVE
LICENSE
ISSUED
4/11/2011 None
N/A
12/17/2012 None
N/A
Secondary Specialty
(Self-Designated)
PALLIATIVE
12/12/2013 PALLIATIVE MEDICINE MEDICINE
11/6/2009
10/3/2011
PEDIATRIC
3/1/2013
7/1/2013
N0754
EVERT, LISA MARIE, MD
EWALEIFOH, BENEDICT
EROMOSELE, MD
4/2/2012
8/29/2008
N9206
EWIDA, ASHRAFE, MD
P5062
EWING, JAMES I, MD
12/17/2012
P5062
EWING, JAMES I, MD
12/17/2012
P5062
P7432
EWING, JAMES I, MD
EXUM, KELVIN, MD
12/17/2012
8/1/2013
N5890
N4405
EYE, RITA ELLEN, MD
EZEANUNA, PROSPERITY
UCHENNA , MD
N6287
EZEKIEL, BENNETT JOHN, MD
6/4/2010
N9852
EZON, DAVID STEVEN, MD
6/3/2011
P1995
EZZATI, MOHAMMAD, MD
2/1/2012
4/1/2011
4/9/2010
11/6/2009
DALLAS
TX
WOODLANDS TX
CRITICAL CARE
ANESTHESIOLOGY
MCCOMB
PHILADELPHIA
HEMATOLOGY/ONCOL
12/17/2017 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
12/17/2017 OGY
HEMATOLOGY/ONCOL
12/17/2017 OGY
8/1/2018 PSYCHIATRY
DALLAS
OBSTETRICS AND
4/9/2015 GYNECOLOGY
TULSA
COLLEGE
INTERNAL MEDICINE SATION
PAIN
MANAGEMENT/REHAB
6/4/2015 MED
PEDIATRICS,
6/3/2016 PEDIATRICS
CARDIOLOGY
REPRODUCTIVE
OBSTETRICS AND
ENDOCRINOLOGY
2/1/2017 GYNECOLOGY
AND INFERTILITY
DALLAS
Page 82 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
4/12/2013 None
N/A
TX
ACTIVE
1/14/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
1/14/2013 None
8/7/2013 None
N/A
N/A
OK
ACTIVE
5/3/2010 None
N/A
TX
ACTIVE
2/3/2010 None
N/A
6/4/2010 None
N/A
6/3/2011 None
N/A
2/17/2012 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
License
Number
Physician Name
P5178
FABELA, PAUL ANDREW, MD
FADAHUNSI, TITILOLA
N9543
OLUJUMOKE, MD
dicaid
dicaid
Agreement
End Date
Designated)
1/4/2013
OBSTETRICS AND
5/2/2011
5/2/2016 GYNECOLOGY
N5045
P5063
P5063
P5063
FAGLIE, BRAD D, MD
FAHOURY, ALEX IBRAHIM, MD
N9366
FAIG, OFER, MD
N3638
FAIRLESS, JUSTIN WALTER, DO
FAJARDO, ARTHUR BERNARD TIU,
MD
8/21/2009
11/4/2011
N8782
FAKIR, SAMI M, MD
FALDU, HIRENKUMAR AMRUTLAL,
MD
N4406
FAN, IAIN , DO
11/6/2009
P0207
FANG, XIANG , MD
N1317
N8003
P3149
FANNING, JEFFREY JOHN, MD
FARAG, ASHRAF NABIL, MD
FARAHAT, ALAA, MD
H8635
FARHI, DIANE C, MD
P6614
FARKAS, JORDAN PHILLIP, MD
N9853
P1640
FARO, JONATHAN PAUL, MD
FAROUSSI, SAWSAN, MD
P2237
FARR, MICHAEL BENJAMIN, DO
FARRACH, HUSSEM ALEJANDRO,
MD
FARRAG, SAFA ELSEBAI, MD
N7255
P1299
P1457
P7109
2/5/2010
12/17/2012
12/17/2012
12/17/2012
4/8/2011
8/2/2010
2/15/2011
7/1/2011
10/10/2008
10/29/2010
5/15/2012
2/4/2011
5/15/2013
6/3/2011
12/15/2011
3/1/2012
11/15/2011
7/1/2013
2/5/2015
12/17/2017
12/17/2017
12/17/2017
FAMILY MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
EMERGENCY
4/8/2016 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
DIAGNOSTIC
11/4/2016 RADIOLOGY
Secondary Specialty
(Self-Designated)
HOSPITALIST
HOSPITALIST
HOSPITALIST
Practice City
DENTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
MCKINNEY
TX
BROCKPORT
BROCKPORT
BROCKPORT
NY
NY
NY
KERMIT
NUCLEAR MEDICINE DETROIT
5/9/2011 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
4/15/2011 None
N/A
ACTIVE
8/31/2009 None
N/A
TX
ACTIVE
8/27/2010 None
N/A
MI
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
11/15/2011 None
N/A
2/15/2011 None
N/A
11/6/2009 None
N/A
7/1/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
10/15/2008 None
11/3/2010 None
5/16/2012 None
N/A
N/A
N/A
2/4/2011 None
N/A
ACTIVE
6/20/2013 None
N/A
ACTIVE
ACTIVE
6/14/2011 None
12/20/2011 None
N/A
N/A
ACTIVE
3/13/2012 None
N/A
ACTIVE
ACTIVE
11/25/2011 None
7/4/2013 None
N/A
N/A
DIAGNOSTIC
11/6/2014 RADIOLOGY
7/1/2016 NEUROLOGY
PEDIATRIC CRITICAL
2/4/2016 PATHOLOGY
PLASTIC &
RECONSTRUCTIVE
5/15/2018 SURGERY
OBSTETRICS AND
6/3/2016 GYNECOLOGY
ORTHOPEDIC
3/1/2017 SURGERY
NEPHROLOGY
DALLAS
TX
BROOKLYN
NY
FORT DODGE IA
DALLAS
CYTOPATHOLOGY
EMERGENCY
MEDICINE
Page 83 of 300
HOUSTON
JACKSON
ARDMORE
EL PASO
TX
TX
MS
OK
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/7/2013 None
N/A
License
Number
N7920
Physician Name
FARRICIELLI, ELLA VIKTOROVNA,
MD
dicaid
dicaid
Agreement
End Date
Designated)
10/15/2010
P3528
N9544
FARZAN, THAHIR , MD
FARZANEH-FAR, RAMIN, MD
N7616
N3640
FASINA, ABIOLA A, MD
FATEMI, OMID , MD
9/1/2010
8/21/2009
P7763
8/30/2013
P4646
FAUSETT, MERLIN BARDETT, MD
FAWEYA, AYOTUNDE GREGORY,
MD
N8507
FAY, KARI H, MD
P4865
P4441
FAYAD, ZIAD YOUSSEF, MD
FEDARAU, MAKSIM
ALEKSANDROVICH, MD
FEDERICO, MASSIMO DOMENICO,
MD
N8783
FEDOR, PRESTON JOSEPH, MD
P1751
FEIGENBAUM, FRANK, MD
1/2/2012
P5974
FELDMAN, LILIYA, MD
4/1/2013
N5673
FELICIANO, CALEB ENRIQUE, MD
FELICITAS, PATRICK STEPHEN
TAN, MD
4/9/2010
NEUROLOGICAL
4/9/2015 SURGERY
2/15/2011
P6813
N8784
N6291
P0975
FELIX, JUAN CARLOS, MD
FELIZ RODRIGUEZ, NILSON DAVID,
MD
N6292
P0208
6/8/2012
5/2/2011
GYNECOLOGIC
6/8/2017 ONCOLOGY
5/2/2016 CARDIOLOGY
EMERGENCY
9/1/2015 MEDICINE
MATERNAL AND
10/15/2012
1/18/2011
11/15/2012
6/3/2013
9/17/2012
2/15/2011
6/4/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
GYNECOLOGIC
SURGERY
AMARILLO
TX
TX
HOUSTON
TX
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
STARKE
FL
EMERGENCY
9/17/2017 MEDICINE
EMERGENCY
2/15/2016 MEDICINE
NEUROLOGICAL
1/2/2017 SURGERY
HEMATOLOGY
FORT HOOD
TX
KANSAS CITY MO
ANATOMIC/CLINICAL ELMWOOD
PATHOLOGY
PARK
NJ
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
SAN JUAN
PR
6/4/2015 PATHOLOGY
CYTOPATHOLOGY
9/15/2011
FELLMAN, KIM-NGAN PHAM, MD
6/4/2010
FELTON, JASON ANDREW, MD
7/1/2011
NEUROLOGICAL
7/1/2016 SURGERY
ABILENE
TX
HOSPITALIST
Page 84 of 300
LUBBOCK
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
10/27/2010 None
N/A
ACTIVE
ACTIVE
6/11/2012 None
6/15/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/8/2010 None
8/31/2009 None
N/A
N/A
8/30/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
11/30/2012 None
N/A
1/18/2011 None
N/A
11/15/2012 None
N/A
6/3/2013 None
N/A
ACTIVE
LICENSE
ISSUED
9/19/2012 None
N/A
2/15/2011 None
N/A
ACTIVE
1/9/2012 None
N/A
ACTIVE
4/12/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/27/2010 None
N/A
2/15/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/21/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
7/28/2011 None
N/A
License
Number
Physician Name
N7421
P2238
FELTON, SHAILI KHANDHERIA, MD
FENG, ZICHUN , MD
N4410
FENTON, STEPHEN JOSEPH, MD
FERGUSON, ANGELA GREMILLION,
DO
P7436
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
ENDOCRINOLOGY,
DIABETES AND
8/16/2010
INTERNAL MEDICINE
3/1/2012
HOUSTON
LACKLAND
11/6/2009
AFB
8/1/2013
P7271
FERGUSON, MATTHEW PAUL, MD
N5051
FERNANDEZ, GEOVER , MD
P1301
FERNANDEZ, JIMMY DANIEL, MD
P6815
N8095
P2439
FERNANDEZ, JUAN FELIPE, MD
FERNANDEZ, MARIO BENJAMIN,
MD
FERNANDEZ-GRELA, MARIO JUAN,
MD
FERNANDO, SANTHI, MD
P2440
FERONTI, CHARLES JAMES, DO
N8006
P1996
N8186
P0209
P3529
FERRINI, VINCENT FRANK III, MD
FERRUFINO, LUIS EDGARDO, MD
FETSAK, ANDRIY, MD
FEY, VICTOR, MD
FIELDS, JOANNA RENEE, MD
10/29/2010
2/1/2012
12/1/2010
7/1/2011
6/8/2012
P1072
N0763
FIERKE, SHELBY RYAN, MD
FIGUEREDO, GIOVANNA, MD
FIGUEROA, STEPHEN ANDREW,
MD
10/3/2011
8/29/2008
N7256
N9545
P3321
FILETTI, LUSIA CRISTINA, MD
7/15/2013
2/5/2010
11/4/2011
6/3/2013
8/2/2010
11/15/2010
3/15/2012
3/15/2012
5/2/2011
6/1/2012
ORTHOPEDIC
7/15/2018 SURGERY
DERMATOLOGIC
2/5/2015 SURGERY
PULMONARY
CRITICAL CARE
6/3/2018 MEDICINE
EMERGENCY
8/2/2015 MEDICINE
EMERGENCY
3/15/2017 MEDICINE
UNDERSEA
HYPERBARIC MED
10/29/2015 (EMER MED)
10/3/2016 RADIOLOGY
HOSPITALIST
CARDIOTHORACIC
ANESTHESIOLOGY
PSYCHIATRY
HOSPITALIST
FAMILY PRACTICE
PEDIATRIC
RADIOLOGY
5/2/2016 NEUROLOGY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 85 of 300
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
ACTIVE
8/19/2010 None
3/9/2012 None
N/A
N/A
TX
ACTIVE
11/16/2009 None
N/A
LUBBOCK
TX
ACTIVE
8/5/2013 None
N/A
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
8/23/2013 None
N/A
2/5/2010 None
SEE
PREVIOUS
12/15/2011 ORDER
N/A
SAN ANTONIO TX
ACTIVE
EL PASO
ACTIVE
6/14/2013 None
N/A
ACTIVE
8/5/2010 None
N/A
FL
TX
ACTIVE
ACTIVE
12/8/2010 None
4/17/2012 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
4/19/2012 None
N/A
MCALLEN
HOUSTON
CLINTON
LAREDO
TX
TX
OK
TN
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/29/2010
2/6/2012
12/6/2010
7/12/2011
6/18/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
CINCINNATI
HOUSTON
OH
TX
ACTIVE
ACTIVE
10/12/2011 None
12/1/2008 None
N/A
N/A
ACTIVE
5/6/2011 None
N/A
LICENSE
ISSUED
6/1/2012 None
N/A
LEESBURG
SAN ANGELO
TX
11/16/2011
License
Number
P0582
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
FILIPETTO, FRANK ANTHONY, DO
FILLINGANE, CHARLES SAMUEL II,
DO
8/1/2011
8/1/2013
2/5/2010
P0583
FILSOOF, DAVID MANSOUR, MD
FINIANOS, ANTOINE NAFEZ
NAFEZ, MD
FINNERTY, KATIE NICOLE, MD
FIROUZTALE, PEJMAN AVRAHAM,
MD
P6386
FIRZLI, ELIE SALIM, MD
5/1/2013
P6387
FISHER, CHRISTINE, MD
5/1/2013
N7422
N7258
FISTER, COURTNEY, DO
FITE, MICHAEL QUENTIN, MD
8/16/2010
8/2/2010
H4918
FITZGERALD, DAVID MICHAEL, MD
10/1/2010
P7273
7/15/2013
N5676
FITZGERALD, TAMARA N, MD
FITZPATRICK, THOMAS MICHAEL,
MD
FITZWATER, JOHN WELTON, MD
FLAGGE, MICHELE CATHERINE,
MD
P5975
FLANAGAN, MARK NICHOLAS, DO
4/1/2013
P6816
P2441
N8509
FLETCHER, JEFFREY CLAY JR, DO
FLORES, AMY WALLACE, MD
FLORES, ANGELA THERESE
CAPAY, MD
N7539
FLORES, HECTOR ALEJANDRO,
MD
P1754
FLORES, JOSE, MD
P7438
N5052
N3641
P5627
P2987
P1753
8/21/2009
3/1/2013
8/1/2011
Secondary Specialty
(Self-Designated)
Practice City
SAGINAW
OBSTETRICS
Registration
Status of
Practice
Texas
State
License
TX
PORT LAVACA TX
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/5/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/13/2013 None
N/A
2/5/2010 None
N/A
DIAGNOSTIC
8/1/2016 RADIOLOGY
PEDIATRIC
5/1/2018 NEPHROLOGY
PLASTIC &
RECONSTRUCTIVE
5/1/2018 SURGERY
COSMETIC SURGERY
EMERGENCY
8/16/2015 MEDICINE
CARDIAC
ELECTROPHYSIOLOG
10/1/2015 Y
CARDIOLOGY
LIVINGSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
8/26/2009 None
3/7/2013 None
N/A
N/A
ATLANTA
GA
ACTIVE
8/22/2011 None
N/A
ACTIVE
5/13/2013 None
N/A
AUSTIN
ARLINGTON
HEIGHTS
SUGAR LAND
TX
ACTIVE
6/3/2013 None
N/A
IL
TX
ACTIVE
ACTIVE
8/19/2010 None
9/27/2010 None
N/A
N/A
TEMPLE
TX
ACTIVE
10/19/2010 None
N/A
ORTHOPEDIC
5/1/2017 SURGERY
EMERGENCY
4/9/2015 MEDICINE
EMERGENCY
4/1/2018 MEDICINE
EL PASO
TX
JACKSONVILL
E
TX
LUBBOCK
TX
ACTIVE
8/21/2013 None
N/A
ACTIVE
ACTIVE
6/5/2012 None
1/5/2012 None
N/A
N/A
DALLAS
ACTIVE
LICENSE
ISSUED
4/20/2010 None
N/A
4/1/2013 None
N/A
6/3/2013
3/15/2012
SAN ANTONIO TX
SAN ANTONIO TX
ACTIVE
ACTIVE
7/3/2013 None
3/26/2012 None
N/A
N/A
1/18/2011
THORACIC
CARDIOVASCULAR
8/27/2015 SURGERY
INFECTIOUS
1/2/2017 DISEASES
HOUSTON
ACTIVE
1/31/2011 None
N/A
LICENSE
ISSUED
8/27/2010 None
N/A
ACTIVE
1/10/2012 None
N/A
5/1/2012
1/2/2012
4/9/2010
8/27/2010
1/2/2012
NEONATOLOGY
INTERNAL MEDICINE
Page 86 of 300
TX
TX
dicaid
dicaid
License
Agreement
Physician Name
Start Date
End Date
Designated)
PEDIATRIC
N9547
FLORES, MAURICIO ERNESTO, MD
5/2/2011
P1755
FLORES, RENEE J, MD
1/2/2012
ORTHOPEDIC
N8396
FLOYD, IRA LENORRIS, MD
1/3/2011
1/3/2016 SURGERY
NEUROLOGICAL
N0769
FLOYD, JOHN ROBERT II, MD
8/29/2008
8/29/2013 SURGERY
PEDIATRIC
EMERGENCY
P0211
FLOYED, REBECCA LYNN, MD
7/1/2011
PEDIATRIC EMER MED
N3643
FLYNN, ROCHELLE ROXANNE, MD
8/21/2009
8/21/2014 (PEDS)
EMERGENCY
N8096
FOLAND, MARK JOSHUA, MD
11/15/2010
11/15/2015 MEDICINE
N7086
FOLARIN, HOPE, MD
7/15/2010
P5804
P3623
FONG, ALEXANDER ERIC, MD
FONKEM, EKOKOBE, DO
3/15/2013
6/15/2012
N4412
11/6/2009
P6389
FONTANE, EMILY, MD
FONTANILLA, JOHN RODOLFO GO,
MD
FONTENOT, BENNETT BOUSTANY,
MD
P3322
FOO, WAI CHIN , MD
P6164
FORBES, JOANNA , MD
4/12/2013
P1545
FORNARI, GIANLUIGI ALOISIO, MD
12/1/2011
N9052
FOSTER, PAUL ANDREW, DO
3/15/2011
N4413
P5362
FOSTER, TIMOTHY CHARLES, MD
FOSTER, TROY , DO
11/6/2009
2/1/2013
N8097
FOTE, BARNABAS TALLA, MD
P1863
FOWLER, AJA JENELLE, MD
N9368
4/8/2011
5/1/2013
6/1/2012
11/15/2010
1/17/2012
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
DERBY
CT
ACTIVE
ACTIVE
DEL RIO
TX
ACTIVE
1/7/2011 None
N/A
NEURO-ONCOLOGY
SAN ANTONIO TX
ACTIVE
9/5/2008 None
N/A
TX
ACTIVE
7/11/2011 None
N/A
PEDIATRICS
AUSTIN
CORPUS
CHRISTI
TX
ACTIVE
8/26/2009 None
N/A
AUSTIN
TX
ACTIVE
ACTIVE
12/6/2010 None
7/21/2010 None
N/A
N/A
VASCULAR
NEUROLOGY
NEURO-ONCOLOGY
HOUSTON
TEMPLE
TX
TX
ACTIVE
ACTIVE
4/23/2013 None
6/18/2012 None
N/A
N/A
PEDIATRICS
HOUSTON
TX
ACTIVE
12/15/2009 None
N/A
TX
ACTIVE
4/18/2011 None
N/A
ANATOMIC
6/1/2017 PATHOLOGY
OBSTETRICS AND
PLASTIC SURGERY
SELECTIVE
PATHOLOGY
HOUSTON
TX
ACTIVE
5/6/2013 None
N/A
HOUSTON
TX
ACTIVE
6/7/2012 None
N/A
DALLAS
TX
ACTIVE
4/18/2013 None
N/A
12/1/2016 RADIOLOGY
EMERGENCY
3/15/2016 MEDICINE
BREAST IMAGING
LUBBOCK
TX
ACTIVE
12/30/2011 None
N/A
AUSTIN
NEURODEVELOPMEN
TAL DISABILITIES
(PEDIATRICS)
HOUSTON
TX
ACTIVE
4/6/2011 None
N/A
TX
ACTIVE
ACTIVE
11/13/2009 None
2/6/2013 None
N/A
N/A
LA
ACTIVE
LICENSE
ISSUED
2/10/2011 None
N/A
1/17/2012 None
N/A
3/15/2018 NEUROLOGY
6/15/2017 NEUROLOGY
EMERGENCY
11/6/2014 MEDICINE
4/8/2016 NEPHROLOGY
OCCUPATIONAL
11/15/2015 MEDICINE
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
Page 87 of 300
NEW
ORLEANS
5/9/2011 None
2/14/2012 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
3/15/2012
3/15/2017 MEDICINE
ANESTHESIOLOGY 8/2/2010
CARDIOTHORACIC
11/30/2012
DERMATOLOGIC
5/1/2012
5/1/2017 SURGERY
INTERVENTIONAL
11/30/2012
P2443
FOWLER, MICHELE MARIE, DO
N7259
FOWLER, ROBIN JAMES, MD
P4950
FOX, LINDSAY ARNOULT, MD
P2988
FOX, MATTHEW C, MD
P4951
FOX, WILLIAM CORY, MD
N6301
FOXX, TRAVIS S, MD
6/4/2010
P2239
FRACHTMAN, STEVEN JAY, MD
3/1/2012
GASTROENTEROLOG
3/1/2017 Y
N6302
FRANCE, RATCHNEE -, MD
FRANCESCONI, JAMES EDWARD,
MD
FRANCIS, MARK LEE, MD
FRANCIS, MAUREEN DOROTHY,
MD
6/4/2010
6/15/2012
4/9/2010
6/15/2017 NEUROLOGY
1/18/2011
EMERGENCY
6/3/2016 MEDICINE
P3624
N5679
N8511
N9855
Registration
Status Date
Disciplinary
Status Date
TX
ACTIVE
4/6/2012 None
N/A
ANESTHESIOLOGY
CONYERS
GA
ACTIVE
9/9/2010 None
N/A
ANESTHESIOLOGY
HOUSTON
TX
ACTIVE
12/5/2012 None
N/A
DERMATOLOGY
DIAGNOSTIC
RADIOLOGY
AUSTIN
TX
ACTIVE
5/18/2012 None
N/A
SUGARLAND
TX
ACTIVE
LICENSE
ISSUED
12/5/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
3/15/2012 None
N/A
6/4/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
6/20/2012 None
4/28/2010 None
N/A
N/A
EL PASO
CORPUS
CHRISTI
TX
ACTIVE
1/26/2011 None
N/A
TX
ACTIVE
6/17/2011 None
N/A
SHERMAN
P5065
N5056
FRANCO, ZURISADAI, MD
2/5/2010
P2643
FRANKFURT, JOSHUA AARON, MD
4/2/2012
NEONATAL4/2/2017 PERINATAL MEDICINE NEONATOLOGY
P4569
FRATTARELLI, TEASHA-LEE A, DO
10/1/2012
N8785
N0771
FRAYSER, SHELLY FRANCES, MD
FRAZIER, STACEY ANNE, MD
2/15/2011
8/29/2008
P5364
FREDIEU, ANDRE, MD
P5065
Practice City
Disciplinary
Status of
Texas
License
HOUSTON
FRANCIS, TODD LLEWELLYN, DO
FRANCISCO, ANNA MARIE
TUNGOL, MD
TUNGOL, MD
TUNGOL, MD
P5065
6/3/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
12/17/2012
ODESSA
TX
ACTIVE
1/7/2013 None
N/A
12/17/2012
ODESSA
TX
ACTIVE
1/7/2013 None
N/A
12/17/2012
ODESSA
TX
ACTIVE
LICENSE
ISSUED
1/7/2013 None
N/A
2/5/2010 None
N/A
4/9/2012 None
N/A
2/1/2013
EMERGENCY
2/15/2016 MEDICINE
INTERVENTIONAL
2/1/2018 RADIOLOGY
NEUROLOGY
Page 88 of 300
DALLAS
TX
ACTIVE
AKRON
OH
10/4/2012 None
N/A
LAS CRUCES
NM
ACTIVE
LICENSE
ISSUED
ACTIVE
2/15/2011 None
10/7/2008 None
N/A
N/A
PLANO
TX
ACTIVE
2/21/2013 None
N/A
License
Number
P0826
N2507
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
ORTHOPEDIC
8/26/2011
8/26/2016 SURGERY
4/3/2009
4/3/2014 PEDIATRICS
N5057
N6870
FREEDHAND, ADAM M, MD
FREEMAN, ASHA MARIE, MD
FREEMAN-LADD, MAYRA LOUISE,
MD
FREITAG, FREDERICK G., DO
N8786
P3150
FREMION, ELLEN JEAN, MD
FRIDAY, DWAYNE, MD
P4952
FRIEBEN, RYAN WILLIAM, MD
P1302
FRIEDLAND, JOHN T, MD
11/4/2011
P1864
FRIEDMAN, DEBORAH ISA, MD
1/17/2012
P5275
FRIEDMAN, DUNCAN AESCTUN,
MD
1/15/2013
N4415
2/5/2010
7/1/2010
2/15/2011
5/15/2012
11/30/2012
FRIEL, LARA ANNE , MD
FRIERSON, SABRINA DEBRA
TRIEFF, MD
11/6/2009
5/29/2009
P4648
FRINK, SPENCER JAMES SR, MD
FRISCHHERTZ, BENJAMIN PAUL,
MD
P5531
FRITTS, AARON HASKELL, MD
P1303
FRYBARGER, JAMES ROBERT, MD
11/4/2011
N3036
FUCHS, JULIE ROBIN , MD
5/29/2009
P0977
N3654
FULLER, CLIFTON DAVID, MD
FURBEE, JON MARK, DO
9/15/2011
8/21/2009
N5682
FURLAN, JULIE ENRIGHT, MD
FURUKAWA, BRIAN SHIGENOBU,
MD
GADAM, MOHAN RAVINDRA, MD
N7796
N3035
N7424
P0384
10/1/2010
10/15/2012
2/8/2013
4/9/2010
8/16/2010
7/15/2011
Secondary Specialty
(Self-Designated)
Practice City
PEDIATRICS
DALLAS
EL PASO
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
ORTHOPEDIC
5/29/2014 SURGERY
DIAGNOSTIC
2/8/2018 RADIOLOGY
EMERGENCY
11/4/2016 MEDICINE
OPHTHALMOLOGY VITREOUS SURGERY BIRMINGHAM
MATERNAL AND
FETAL MEDICINE
HOUSTON
MARSHALL
Disciplinary
Status Date
8/26/2011 None
5/7/2009 None
N/A
N/A
2/5/2010 None
7/8/2010 None
N/A
N/A
2/15/2011 None
5/16/2012 None
N/A
N/A
ACTIVE
12/31/2012 None
N/A
ACTIVE
11/16/2011 None
N/A
ACTIVE
1/23/2012 None
N/A
AL
ACTIVE
1/17/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
11/16/2009 None
N/A
10/1/2010 None
N/A
ACTIVE
6/15/2009 None
N/A
11/30/2017 UROLOGIC SURGERY UROLOGIC SURGERY HOUSTON
TX
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
11/4/2016 SURGERY
SPINE
SAN ANTONIO TX
NEURO1/17/2017 NEUROLOGY
OPHTHALMOLOGY
DALLAS
TX
OBSTETRICS AND
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
SAN ANTONIO TX
INTERVENTIONAL
RADIOLOGY
PLANO
TX
ACTIVE
10/18/2012 None
N/A
TX
ACTIVE
2/20/2013 None
N/A
HOUSTON
TX
ACTIVE
11/10/2011 None
N/A
5/29/2014 PEDIATRIC SURGERY GENERAL SURGERY DALLAS
RADIATION
9/15/2016 ONCOLOGY
HOUSTON
TAVARES
LACKLAND
AFB
FAMILY PRACTICE
AUSTIN
Page 89 of 300
TX
ACTIVE
6/3/2009 None
N/A
TX
FL
ACTIVE
ACTIVE
11/2/2011 None
9/3/2009 None
N/A
N/A
ACTIVE
4/20/2010 None
N/A
ACTIVE
ACTIVE
8/23/2010 None
7/21/2011 None
N/A
N/A
TX
TX
License
Number
P3152
P6167
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5179
GADDIS, TODD DONAVON, MD
GADHIA, HETAL TALSI, DO
GAFFNEY, KRISTIN ALEXANDRIA,
DO
5/15/2012
4/12/2013
P6818
GAFFORD, PHILIP SCOTT, MD
6/3/2013
N2513
GAGE, EARL ANTHONY , MD
4/3/2009
N3655
GAGRICA, MELISA HELENE, MD
P6391
GAINES, ROBERT J, MD
N7542
P0585
GAJJAR, AAKASH HASMUKH, MD
GAJWANI, PRASHANT, MD
8/27/2010
8/1/2011
N0774
GALES, MARIA SUZANNE, MD
8/29/2008
P7441
GALINANES, EDGAR LUIS, MD
8/1/2013
P4445
GALL, JOHN ANTHONY, MD
1/4/2013
8/21/2009
5/1/2013
9/17/2012
GASTROENTEROLOG
1/4/2018 Y
INTERNAL MEDICINE
SURGICAL
6/3/2018 GENERAL SURGERY ONCOLOGY
CRANIOFACIAL
SURGERY
EMERGENCY
8/21/2014 MEDICINE
ORTHOPEDIC
TRAUMATIC
5/1/2018 SURGERY
SURGERY
COLON AND RECTAL
8/27/2015 SURGERY
GENERAL SURGERY
8/1/2016 PSYCHIATRY
PEDIATRIC EMER MED
8/29/2013 (EM)
PEDIATRICS
N1322
10/10/2008
P1757
GALLAGHER, SEAN MICHAEL, MD
1/2/2012
ORTHOPEDIC
1/2/2017 SURGERY
N9371
4/8/2011
N2079
N8916
GALLANT, JAMES FRANCIS, MD
GALLEGOS GARCIA, FERNANDO
SALVADOR, MD
GALLEGOS, PHILLIP , MD
2/6/2009
3/1/2011
N9548
GALLOWAY, LAURA JEAN, MD
5/2/2011
5/2/2016 PEDIATRICS
N6304
N7617
GALVAN, CARLOS ALBERTO, MD
GALVAN, KRISTOFER ISAMU, MD
6/4/2010
9/1/2010
8/1/2013
HEAD AND NECK
8/1/2018 SURGERY
Page 90 of 300
Disciplinary
Status Date
5/15/2012 None
4/23/2013 None
N/A
N/A
ACTIVE
1/18/2013 None
N/A
TX
ACTIVE
7/1/2013 None
N/A
DALLAS
TX
ACTIVE
4/14/2009 None
N/A
DALLAS
TX
ACTIVE
9/14/2009 None
N/A
LUBBOCK
TX
ACTIVE
5/3/2013 None
N/A
GALVESTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
9/1/2010 None
8/11/2011 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
10/31/2008 None
N/A
8/1/2013 None
N/A
OTOLARYN & FACIAL
PLASTIC SURGERY
HOUSTON
CARDIOTHORACIC
ANESTHESIOLOGY
DALLAS
ADULT
RECONSTRUCTION AUSTIN
Registration
Status Date
Disciplinary
Status of
Texas
License
MIDLAND
GENERAL VASCULAR
8/1/2018 VASCULAR SURGERY SURGERY
EMERGENCY
9/17/2017 MEDICINE
COLUMBUS
GALLAGHER, KATHLEEN KELLY,
MD
GALLAGHER, MICHAEL PATRICK,
MD
P7442
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
DECATUR
BRYAN,
TEXAS
DALLAS
AUSTIN
LICENSE
ISSUED
IN
ACTIVE
11/21/2012 None
N/A
TX
ACTIVE
8/9/2013 None
N/A
TX
ACTIVE
12/5/2008 None
N/A
TX
ACTIVE
LICENSE
ISSUED
1/4/2012 None
N/A
4/8/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
2/24/2009 None
3/4/2011 None
N/A
N/A
5/2/2011 None
N/A
6/4/2010 None
10/22/2010 None
N/A
N/A
TX
TX
TX
TX
License
Number
N7797
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P7766
N8188
GAMARNIK, SHARI CAROLYN, MD
GAMBAROTA, MARCI CATHERINE,
MD
GAMBOA, DANIELA , MD
10/1/2010
N2517
GANDHI, MANISHA , MD
N7087
P1642
N8295
GANDHI, MIHIRKUMAR, MD
GANO, HEATHER MARIE, MD
GANTA, NEELIMA, MD
N9055
GAO, JIANJUN , MD
N9857
GARCIA, ANGEL JOEL, MD
N9056
GARCIA, BRIANA, MD
N6306
GARCIA, CESAR HUMBERTO, MD
6/4/2010
P3328
GARCIA, CESAR JOSE, MD
6/1/2012
8/30/2013
12/1/2010
4/3/2009
7/15/2010
12/15/2011
12/15/2010
3/15/2011
6/3/2011
3/15/2011
2/4/2011
EMERGENCY
8/30/2018 MEDICINE
MATERNAL AND
CRITICAL CARE
7/15/2015 MEDICINE
HEMATOLOGY/ONCOL
3/15/2016 OGY
Secondary Specialty
(Self-Designated)
GARCIA, CLARISA YSELA, MD
N1642
GARCIA, HERNANDO , MD
12/12/2008
2/4/2016 PEDIATRICS
PULMONARY
12/12/2013 MEDICINE
P1180
GARCIA, JESSICA , DO
10/17/2011
DALLAS
TX
AMARILLOT
TX
HOUSTON
TX
DALLAS
TX
PALLIATIVE
MEDICINE
OBSTETRICS AND
GYNECOLOGY
EMERGENCY
3/15/2016 MEDICINE
N8652
Practice City
EL PASO
DERMATOPATHOLO
GY
GARCIA, JULIAN ALBERT, MD
GARCIA, KEITH SIGMOND, MD
2/6/2009
9/15/2010
2/6/2014 PATHOLOGY
P0978
P6618
GARCIA, LUIS EDMUNDO, MD
GARCIA, STEVEN GARZA, MD
9/15/2011
5/15/2013
P1307
GARDA, JACQUELINE LABOE, DO
11/4/2011
P2242
GARDNER, KIMBERLY RENEE, MD
3/1/2012
OBSTETRICS AND
EMERGENCY
3/1/2017 MEDICINE
N9859
GAREWAL, ARVIND SINGH, MD
6/3/2011
TX
TX
GERIATRICS
PEDIATRICS,
CARDIOLOGY
CRITICAL CARE
MEDICINE
N2082
N7696
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
ACTIVE
Disciplinary
Status Date
10/4/2010 None
N/A
8/30/2013 None
12/23/2010 None
N/A
N/A
5/5/2009 None
N/A
7/15/2010 None
12/29/2011 None
12/29/2010 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
3/28/2011 None
N/A
6/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/8/2011 None
N/A
6/4/2010 None
N/A
6/1/2012 None
N/A
2/4/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
EL PASO
CORPUS
CHRISTI
TX
ACTIVE
12/17/2008 None
N/A
TX
ACTIVE
12/1/2011 None
N/A
SAN ANTONIO
AUSTIN
RIO GRANDE
CITY.
DALLAS
TX
TX
ACTIVE
ACTIVE
2/13/2009 None
9/21/2010 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
9/19/2011 None
5/17/2013 None
N/A
N/A
FT. WORTH
TX
ACTIVE
LICENSE
ISSUED
11/15/2011 None
N/A
LICENSE
ISSUED
Page 91 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
3/1/2012 None
SEE
PREVIOUS
6/3/2011 ORDER
N/A
6/6/2011
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N7262
P0587
GARG, JYOTIKA, MD
GARG, MURARI, MD
8/2/2010
8/1/2011
8/2/2015 PEDIATRICS
P0588
GARG, NADISH, MD
8/1/2011
P6168
GARNER, ERIN PAIGE, DO
P4650
GARRETT, JAMES BRYAN, MD
N5069
GARRETT, JOHN SIGEL, MD
2/5/2010
OBSTETRICS &
GYNECOLOGICAL
4/12/2018 SURGERY
ORAL &
MAXILLOFACIAL
10/15/2017 SURGERY
EMERGENCY
2/5/2015 MEDICINE
P0213
7/1/2011
N9209
P4571
P1308
GARRETT, LAURA MEADOWS, MD
GARZA BERLANGA, ANDRES
EUGENIO, MD
GARZA, AMANDA , MD
GARZA, DELFINO RANDY
ORLANDO, MD
GARZA, HOMERO , MD
GARZA, JOSE E., MD
P6169
GARZA, RALPH ZACHARY, MD
P2648
P4446
P0724
GARZA, TRINI JON, MD
P0589
GASCO-TAMARIT, JAIME , MD
GASKIN, FREDERICK SPENCER,
MD
P6392
P2117
N5070
GASSEN, JOSEPH ARISTIDE III, MD
GATES, CAMERON HERSCHEL JR,
DO
P6393
GATLIN, SCOTT, MD
P7767
GAUTAM, ABHINAV, MD
N6309
GAUTAM, MANJUSHREE, MD
4/12/2013
10/15/2012
4/2/2012
9/17/2012
INTERVENTIONAL
4/2/2017 RADIOLOGY
4/1/2011
10/1/2012
11/4/2011
4/12/2013
8/15/2011
8/1/2011
5/1/2013
2/10/2012
2/5/2010
5/1/2013
8/30/2013
6/4/2010
Secondary Specialty
(Self-Designated)
Practice City
WAYCROSS
CARDIOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
GA
ACTIVE
LICENSE
ISSUED
ABILENE
TX
ACTIVE
COLLEGE
STATION
TX
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
SAN ANTONIO TX
HOUSTON
TX
PEDIATRICS
HOSPITALIST
NEUROLOGICAL
8/1/2016 SURGERY
SEGUIN
TX
PEDIATRICS
6/4/2015 HEPATOLOGY
GASTROENTEROLOG
Y
Page 92 of 300
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
8/2/2010 None
8/9/2011 None
N/A
N/A
8/1/2011 None
N/A
4/17/2013 None
N/A
10/19/2012 None
N/A
2/5/2010 None
N/A
8/8/2011 None
N/A
4/12/2012 None
9/24/2012 None
N/A
N/A
4/1/2011 None
10/23/2012 None
11/9/2011 None
N/A
N/A
N/A
4/12/2013 None
N/A
RIO GRANDE
CITY
TX
ACTIVE
8/19/2011 None
N/A
GALVESTON
TX
ACTIVE
9/6/2011 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/7/2013 None
N/A
2/10/2012 None
N/A
2/5/2010 None
N/A
5/6/2013 None
N/A
8/30/2013 None
N/A
6/4/2010 None
N/A
2/5/2015 RADIOLOGY
PEDIATRICS,
5/1/2018 CARDIOLOGY
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
N9372
N8654
P6969
P2446
Physician Name
GAUTAM, NISCHAL
KRISHNAMURTHY, MD
GAW, LISA WUN KAM, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/8/2011
2/4/2011
N4422
N0780
GAZZANEO, MARIA CAROLINA, MD
GEBARA, NATHALIE, MD
GEDDES-SILVA, SHANNON MARIE ,
MD
GEIGEL, CARLOS OSCAR, MD
6/14/2013
3/15/2012
N9551
GELFAND, YURI MICHAEL, MD
N7088
GELLI, SREEDHAR, MD
N7618
GEMMILL, JENNIFER MARIE, MD
P0052
GENINATTI, MARILYN RAE, MD
N1325
GENNRICH, MICHAEL JAMES, MD
P3154
P4447
GENTILE, MARK PATRICK, MD
GENTRY, JAMES DUSTIN, MD
N8918
GENTRY, JERRY L II, MD
3/1/2011
P0591
GEORGE, ALEX, MD
8/1/2011
N1326
GEORGE, BENJAMIN JACOB, MD
P0214
GEORGE, BRANNON EDWARD, MD
11/6/2009
8/29/2008
5/2/2011
7/15/2010
9/1/2010
6/15/2011
10/10/2008
5/15/2012
9/17/2012
10/10/2008
7/1/2011
2/4/2016 PEDIATRICS
PEDIATRIC INTENSIVE
6/14/2018 CARE
3/15/2017 RADIOLOGY
NEURO-RADIOLOGY
4/15/2011 None
2/10/2011 None
N/A
N/A
HOUSTON
NEW YORK
TX
NY
ACTIVE
ACTIVE
6/20/2013 None
4/4/2012 None
N/A
N/A
HEREFORD
TX
OTORHINOLARYNGOL
5/2/2016 OGY
OTOLARYNGOLOGY
ACTIVE
ACTIVE
1/11/2010 None
10/8/2008 None
N/A
N/A
5/5/2011 None
N/A
7/15/2010 None
N/A
11/1/2010 None
N/A
6/15/2011 None
N/A
EMERGENCY
9/1/2015 MEDICINE
EMERGENCY
6/15/2016 MEDICINE
GEORGE, JOHN MICHAEL, MD
8/15/2013
11/1/2012
8/1/2011
AUSTIN
HEMATOLOGY
(PATHOLOGY)
INTERVENTIONAL
CARDIOLOGY
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
10/20/2008 None
N/A
SAN ANTONIO TX
TYLER
TX
THE
WOODLANDS TX
ACTIVE
ACTIVE
5/22/2012 None
10/26/2012 None
N/A
N/A
ACTIVE
3/16/2011 None
N/A
TX
ACTIVE
8/17/2011 None
N/A
TX
ACTIVE
10/21/2008 None
N/A
HOUSTON
TX
ACTIVE
7/8/2011 None
N/A
HARLINGEN
TX
ACTIVE
LICENSE
ISSUED
7/25/2013 None
N/A
8/15/2013 None
N/A
TX
ACTIVE
8/31/2009 None
N/A
TX
ACTIVE
ACTIVE
11/8/2012 None
8/8/2011 None
N/A
N/A
3/1/2016 GENETICS
PEDIATRIC
HEMATOLOGY/ONCOL
8/1/2016 OGY
HOUSTON
HEMATOLOGY/ONCOL
LACKLAND
10/10/2013 OGY
INTERNAL MEDICINE AFB
P7636
GEORGE, MICHAEL ROBERT, MD
GEORGE, ROSHNY A, MD
TEMPLE
EMERGENCY
5/15/2017 MEDICINE
7/15/2018 PATHOLOGY
P4759
P0592
Disciplinary
Status Date
ACTIVE
ACTIVE
7/15/2013
8/21/2009
Registration
Status Date
AR
GEORGE, ELIAS RODRIGUEZ, MD
GEORGE, MATHEWS LAL, MD
Practice City
Disciplinary
Status of
Texas
License
LITTLE ROCK
P7274
N3664
Secondary Specialty
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Registration
Status of
Practice
Texas
State
License
CORPUS
CHRISTI
OPHTHALMOLOGY 11/1/2017 CORNEA
GENERAL PRACTICE IRVING
Page 93 of 300
License
Number
N5686
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N9703
GEORGE, SANDY, MD
GEORGIADIS, ALEXANDROS
LAZAROS, MD
4/9/2010
5/16/2011
5/16/2016 NEUROLOGY
P3627
GEORGIADIS, PARASKEVI, MD
6/15/2012
N5074
GEORGIOU, KIM D, MD
P1999
N3047
GERARD, JODY, MD
GERRIE, ROBERT DUANE, MD
2/1/2012
5/29/2009
URGENT CARE 2/5/2015 FAMILY PRACTICE
EMERGENCY
2/1/2017 MEDICINE
P2857
P0388
GESLANI, GIOVANNI A, DO
GHADIMI-MAHANI, MOHSEN , MD
4/13/2012
7/15/2011
P4868
GHAFOORI, AHMAD FAWAD, MD
11/15/2012
N7800
N2525
GHATALI, MOHAMMAD AGHIL, MD
GHATTAMANENI, SWAPNA , MD
N2526
GHAZALE, AMAAR HASSAN, MD
4/3/2009
N2527
GHAZI, SAMINA ANSAR, MD
4/3/2009
P2650
GHIA, AMOL JITENDRA, MD
4/2/2012
N2528
N1645
GHISOLI, MAURIZIO LORENZO, MD
GHITH, TAMIM , MD
P3531
GHOBADI, ARMIN , MD
6/8/2012
N6311
GHORAYEB, GHASSAN , MD
6/4/2010
2/5/2010
10/1/2010
4/3/2009
4/3/2009
12/12/2008
Secondary Specialty
(Self-Designated)
UNDERSEA AND
HYPERBARIC MED
(PREV MED)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/20/2011 None
N/A
6/15/2012 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/13/2012 None
6/18/2009 None
N/A
N/A
4/13/2012 None
8/25/2011 None
N/A
N/A
11/15/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
10/13/2010 None
5/6/2009 None
N/A
N/A
TX
ACTIVE
4/8/2009 None
N/A
MI
ACTIVE
6/11/2009 None
N/A
TX
ACTIVE
4/13/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
5/4/2009 None
12/23/2008 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
6/26/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
12/19/2012 None
N/A
ACTIVE
12/19/2012 None
N/A
ACTIVE
12/19/2012 None
N/A
FAMILY MEDICINE
SAN ANTONIO TX
GALVESTON
TX
FAMILY PRACTICE
FABEN
SAN ANOTNIO
GASTROENTEROLOG
4/3/2014 Y
FARMINGTON
HILLS
RADIATION
4/2/2017 ONCOLOGY
HOUSTON
PEDIATRIC
HEMATOLOGY/ONCO
4/3/2014 PEDIATRICS
LOGY
DALLAS
ODESSA
HEMATOLOGY/ONCO
HOUSTON
P5066
GHOSH, LINA, MD
12/17/2012
P5066
GHOSH, LINA, MD
12/17/2012
P5066
GHOSH, LINA, MD
12/17/2012
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
Page 94 of 300
Disciplinary
Status Date
4/9/2010 None
NEONATOLOGY
ONCOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CRITICAL CARE
PULMONARY
4/1/2011
MEDICINE
N9210
GHOSH, PRITAM , MD
N5687
GHOSHEH, BASHAR, MD
4/9/2010
P2000
GHUMMAN, UMAR, MD
2/1/2012
P2993
GIACOMETTI, JOSEPH, MD
5/1/2012
P3532
6/8/2012
P5807
P1866
N9553
GIANATASIO, RYAN MARTIN, MD
GIANOPOULOS, JOHN GEORGE,
MD
GIBBONS, JANICE LYNN, MD
GIBBS, AUBREY CLARK, MD
P2448
N8296
N0788
GIBBY, MARK HYRUM, MD
GIBSON, RACHELE ANN, MD
GIDDALURI, PRAKASH , MD
P0054
GIDVANI, MONISHA PARVIN, MD
6/15/2011
N6312
N3675
GILANI, SYED ABBAS RAZA, MD
GILL, SHIVJIT SINGH, MD
6/4/2010
8/21/2009
P1867
GILLALA, VARSHA REDDY, DO
1/17/2012
P0827
GILLEN, ARIC CHRISTOPHER, MD
8/26/2011
3/15/2013
1/17/2012
5/2/2011
3/15/2012
12/15/2010
8/29/2008
N7698
GILLESPIE, MARCIA ANN, MD
9/15/2010
P3156
GILLETTE, STEPHANIE, MD
5/15/2012
P3332
GILLIAM, BRADLEY DALE, MD
N1647
GILLMAN, NICOLE , MD
N6124
GILMORE, LAURA SHANNON, MD
6/1/2012
12/12/2008
6/4/2010
6/8/2017 NEUROLOGY
MATERNAL AND
5/2/2016 PEDIATRICS
Practice City
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
OPHTHALMOLOGY RECONST SURGERY HOUSTON
VASCULAR
NEUROLOGY
PLANO
OBSTETRICS AND
GYNECOLOGY
AUSTIN
BIRMINGHAM
GATESVILLE
INTERNAL MEDICINE
SEALY
OBSTETRICS AND
GYNECOLOGY
DALLAS
CARDIOVASCULAR
DISEASES
LEAGUE CITY
MATERNAL AND
INTERVENTIONAL
6/4/2015 CARDIOLOGY
PHYSICAL MED. &
OBSTETRICS &
GYNECOLOGICAL
8/26/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
9/15/2015 SURGERY
ORTHOPEDIC
6/1/2017 SURGERY
OBSTETRICS AND
UNDERSEA AND
HYPERBARIC MED
6/4/2015 (PREV MED)
Page 95 of 300
Registration
Status of
Practice
Texas
State
License
WACO
MANGUM
PASADENA
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/14/2011 None
N/A
4/9/2010 None
N/A
2/1/2012 None
N/A
TX
ACTIVE
5/7/2012 None
N/A
TX
ACTIVE
6/13/2012 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
3/19/2013 None
1/30/2012 None
5/18/2011 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
3/19/2012 None
12/29/2010 None
10/31/2008 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/20/2011 None
N/A
6/4/2010 None
8/26/2009 None
N/A
N/A
ACTIVE
1/27/2012 None
N/A
LICENSE
ISSUED
8/26/2011 None
N/A
LICENSE
ISSUED
9/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
5/24/2012 None
N/A
6/1/2012 None
N/A
ACTIVE
2/10/2009 None
N/A
6/4/2010 None
N/A
AL
TX
TX
TX
TX
TX
OK
TX
LICENSE
ISSUED
License
Number
Physician Name
P1868
GINGRICH, KEVIN, MD
N7090
N8919
dicaid
dicaid
Agreement
End Date
Designated)
1/17/2012
P4652
P4956
GINOS, JASON , MD
GIPSON, JASON LOGAN, MD
GIRGIS, GEORGE WAGIH
YOUSSEF, MD
GIRONELLA, ANNA CARMELA
SAGCAL, MD
GIVENS, KELLY , MD
10/15/2012
11/30/2012
N8008
GLADDING, JEFF , MD
10/29/2010
P2244
7/15/2010
3/1/2011
7/15/2015 RADIOLOGY
3/1/2012
PEDIATRIC
PEDIATRICS
N4430
GLASGOW, SEAN C, MD
11/6/2009
P6619
P3333
GLASOW, CHRISTINE ANNE, MD
GLASS, DANIEL ADAM, MD
5/15/2013
6/1/2012
P4957
GLASSMAN, THEODORE, MD
N0791
GLEASON, BONNIE T, MD
8/29/2008
N9706
GLENCROSS, PHILIP MARK, MD
5/16/2011
P6620
GLICK, JONATHAN MICHAEL, MD
5/15/2013
P1643
GO, JON AVERY TAN, MD
12/15/2011
N3048
GOALEY, THOMAS JOHN JR, MD
5/29/2009
N7091
GODEY, SREEDEVI , MD
7/15/2010
P7445
P6622
GODFREY, BENJAMIN ROBERT, DO
GODINEZ, CARLOS DRAEGER JR,
MD
EMERGENCY
8/1/2018 MEDICINE
N6314
GODINEZ-PUEBLA, JUAN , MD
6/4/2010
P3628
GODLEY, STACEY ALECE, MD
6/15/2012
P4448
GODOY, GUILHERME , MD
9/17/2012
8/1/2013
5/15/2013
Practice City
TYLER
COLON AND RECTAL
11/6/2014 SURGERY
PEDIATRICS,
EMERGENCY
11/30/2017 MEDICINE
CRITICAL CARE
OCCUPATIONAL
5/16/2016 MEDICINE
EMERGENCY
5/15/2018 MEDICINE
11/30/2012
Secondary Specialty
(Self-Designated)
RADIATION
6/4/2015 ONCOLOGY
OBSTETRICS AND
UROLOGIC
9/17/2017 ONCOLOGY
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
10/18/2012 None
12/10/2012 None
N/A
N/A
10/29/2010 None
N/A
TX
ACTIVE
11/16/2009 None
N/A
GA
TX
ACTIVE
ACTIVE
5/23/2013 None
6/8/2012 None
N/A
N/A
ACTIVE
12/10/2012 None
N/A
TX
ACTIVE
9/9/2008 None
N/A
FL
ACTIVE
5/24/2011 None
N/A
ACTIVE
LICENSE
ISSUED
5/21/2013 None
N/A
12/15/2011 None
N/A
7/30/2009 None
N/A
7/15/2010 None
N/A
8/6/2013 None
N/A
ACTIVE
LICENSE
ISSUED
5/17/2013 None
N/A
6/4/2010 None
N/A
TX
TX
ALTANTA
TYLER
MIDDLETOWN CT
WACO
TX
HOUSTON
TX
JACKSONVILL
E
FL
Page 96 of 300
3/13/2012 None
HOUSTON
WACO
PHYSICAL MED. &
REHABILITATION
LARGO
UROLOGY
N/A
N/A
ACTIVE
LACKLAND
GENERAL SURGERY AFB
CRITICAL CARE
(SURGERY)
7/15/2010 None
4/25/2011 None
SAN ANTONIO TX
PEDIATRICS
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/26/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
SPRING
TX
ACTIVE
6/27/2012 None
N/A
HOUSTON
TX
ACTIVE
9/28/2012 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
DIAGNOSTIC
12/17/2012
DIAGNOSTIC
12/17/2012
DIAGNOSTIC
12/17/2012
INTERVENTIONAL
6/15/2011
6/15/2016 RADIOLOGY
DIAGNOSTIC
3/1/2011
3/1/2016 RADIOLOGY
7/15/2010
12/17/2012
12/17/2012
12/17/2012
PSYCHOSOMATIC
8/29/2008
8/29/2013 MEDICINE
GASTROENTEROLOG
3/1/2012
3/1/2017 Y
7/15/2010
10/3/2011
EMERGENCY
5/15/2012
5/15/2017 MEDICINE
P5068
Physician Name
GODOY, MYRNA COBOS BARCO,
MD
MD
MD
P0055
GOEI, ANTHONY DHIANTIE, MD
TM00420
N7092
P5069
P5069
P5069
N0795
GOEL, NIRMIT, MD
GOEL, SHIV KUMAR, MD
GOENTZEL, BRIAN JOHN, MD
GOFORTH, HAROLD WILLIAM JR,
MD
P2246
N7093
P1076
GOGIA, SUDHANSHU, MD
GOGINENI, SRIKANTH, MD
GOKAPAI, MADHUMATHI, MD
P3158
GOLDBERG, SCOTT, MD
P4958
GOLDFARB, DAVID WOLFF, MD
11/30/2012
N9213
N3677
GOLDSTEIN, BRIAN SETH, MD
GOLDSTEIN, PETER ELLIOT, MD
4/1/2011
8/21/2009
N8788
GOLDSTEIN, SARA B, DO
2/15/2011
N5078
GOLESKI, MARK JOSEPH, MD
N7264
P6623
GOLI, ANIL KUMAR, MD
GOLI, KRISHNA, MD
8/2/2010
5/15/2013
P1644
N2088
GOLLA, PRADEEP, DO
GOLLA, SAILAJA , MD
12/15/2011
2/6/2009
P6399
N9860
N7426
GOLUB, VITALY, MD
GOMAN, ELIZABETH J, MD
GOMEZ, MONICA MARIE, MD
P5068
P5068
2/5/2010
5/1/2013
6/3/2011
8/16/2010
11/30/2017 UROLOGY
PEDIATRICS,
4/1/2016 CARDIOLOGY
Secondary Specialty
(Self-Designated)
CARDIOTHORACIC
RADIOLOGY
CARDIOTHORACIC
RADIOLOGY
CARDIOTHORACIC
RADIOLOGY
PALLIATIVE
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
12/31/2012 None
N/A
HOUSTON
TX
ACTIVE
12/31/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
12/31/2012 None
N/A
6/15/2011 None
N/A
3/16/2011
7/27/2010
1/2/2013
1/2/2013
1/2/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
EDEN PRAIRIE
SAN ANTONIO
TEMPLE
TEMPLE
TEMPLE
MN
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DURHAM
NC
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
9/5/2008 None
N/A
3/1/2012 None
7/21/2010 None
10/9/2011 None
N/A
N/A
N/A
TX
ACTIVE
6/22/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/6/2012 None
N/A
4/1/2011 None
10/21/2009 None
N/A
N/A
2/15/2011 None
N/A
2/5/2010 None
N/A
INTERNAL MEDICINE
HOSPITALIST
EMERGENCY
MEDICAL SERVICES DALLAS
TX
SAN ANTONIO TX
CARDIOVASCULAR
ELECTROPHYSIOLO
8/2/2015 DISEASES
GY
5/15/2018 NEUROLOGY
NEURO-ONCOLOGY
EMERGENCY
12/15/2016 MEDICINE
PEDIATRICS
INFECTIOUS
5/1/2018 DISEASES
INTERNAL MEDICINE
Page 97 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
HARLINGEN
VICKSBURG
OLYMPIA
FIELDS
DALLAS
TX
MS
ACTIVE
ACTIVE
8/13/2010 None
7/12/2013 None
N/A
N/A
IL
TX
ACTIVE
ACTIVE
12/19/2011 None
2/18/2009 None
N/A
N/A
FORT WORTH TX
KYLE
TX
ACTIVE
ACTIVE
ACTIVE
5/28/2013 None
6/13/2011 None
9/2/2010 None
N/A
N/A
N/A
License
Number
P0725
Physician Name
GOMEZ-MEADE, CARLEY ANNE,
DO
P0829
GOMEZ-MEADE, CARLOS, DO
N3678
GONGORA, ENRIQUE, MD
N7266
GONZALEZ FELDMAN, EDGARD
IVAN, MD
GONZALEZ GIBLER, DAVID
PATRICIO, MD
P6625
GONZALEZ MONTOYA, VICTOR
HUGO, MD
N9863
N3683
N9861
N3680
GONZALEZ RANGEL, ISMAEL
ENRIQUE , MD
GONZALEZ, ADAN , MD
GONZALEZ, ARTURO GABRIEL ,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
8/15/2011
PEDIATRICS
MOHS
MICROGRAPHIC
8/26/2011
SURGERY
CARDIOVASCULAR
TRANSPLANT
8/21/2009
8/21/2014 SURGERY
SURGERY
ENDOCRINOLOGY,
DIABETES AND
6/3/2011
6/3/2016 INTERNAL MEDICINE METABOLISM
8/2/2010
8/21/2009
6/3/2011
8/21/2009
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
ORTHOPEDIC
9/15/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
7/1/2018 SURGERY
P0979
GONZALEZ, CARLOS, MD
P7113
GONZALEZ, DELIA , MD
P2860
GONZALEZ, ENRIQUE , MD
4/13/2012
P0056
GONZALEZ, JAVIER , MD
6/15/2011
6/15/2016 NEUROLOGY
P5182
GONZALEZ, LORENA , MD
N7925
P4959
N0799
P2249
GONZALEZ, MANDY MARIE, MD
GONZALEZ, MARIO G, MD
GONZALEZ, NARCISO III, MD
GONZALEZ-AYALA, RAFAEL , MD
GONZALEZ-BERRIOS, NEREIDA,
MD
P5071
7/1/2013
1/4/2013
ACTIVE
8/22/2011 None
N/A
HOLLYWOOD
FL
ACTIVE
9/2/2011 None
N/A
TEMPLE
TX
ACTIVE
10/5/2009 None
N/A
LICENSE
ISSUED
6/3/2011 None
N/A
ACTIVE
9/6/2010 None
N/A
5/15/2013 None
N/A
11/19/2009 None
6/13/2011 None
N/A
N/A
SAN ANTONIO TX
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
ACTIVE
KATY
TX
ACTIVE
9/1/2009 None
N/A
EL PASO
TX
ACTIVE
9/21/2011 None
N/A
AUSTIN
TX
ACTIVE
7/4/2013 None
SEE
PREVIOUS
4/13/2012 ORDER
N/A
6/15/2011 None
N/A
1/28/2013 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
NEURO-ONCOLOGY
10/15/2010
11/30/2012
8/29/2008
3/1/2012
OBSTETRICS AND
FAMILY PRACTICE
PAIN MANAGEMENT
12/17/2012
Page 98 of 300
Disciplinary
Status Date
FL
CLINICAL
NEUROPHYSIOLOGY
5/15/2018 NEUROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
MIAMI
5/15/2013
9/15/2011
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
EL PASO
TX
SAN ANTONIO TX
EL PASO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/15/2010
12/6/2012
9/9/2008
3/9/2012
4/16/2012
None
None
None
None
N/A
N/A
N/A
N/A
12/17/2012 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
P2654
Physician Name
MD
MD
GONZALEZ-SCARANO,
FRANCISCO ANTONIO, MD
GONZALEZ-STAWINSKI, GONZALO
VICENTE, MD
N6877
GOODGAME, BOONE, MD
P7638
P3629
N8099
GOODMAN, OLGA, MD
GOODMAN, SAMANTHA HIRSCH,
MD
GOODPASTOR, SARAH , MD
P7449
GOODSETT, JAMES ROBERT, MD
8/1/2013
P7114
7/1/2013
P5978
GOODWIN, JULIA, MD
GOPALAKRISHNAN, RAJALAKSHMI
THIRUNELLAI, MD
OBSTETRICS &
GYNECOLOGICAL
7/1/2018 SURGERY
4/1/2013
4/1/2018 NEPHROLOGY
N6320
GOPATHI, SWAPNA KUMAR, MD
6/4/2010
P5071
P5071
P1253
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/17/2012
MCALLEN
TX
ACTIVE
2/8/2013 None
N/A
12/17/2012
MCALLEN
TX
ACTIVE
2/8/2013 None
N/A
10/17/2011
CARDIOVASCULAR
TRANSPLANT
4/2/2017 SURGERY
SURGERY
HEMATOLOGY/ONCOL
7/1/2015 OGY
INTERNAL MEDICINE
INTERNAL MED 8/15/2018 RHEUMATOLOGY
PEDS
SAN ANTONIO TX
ACTIVE
10/25/2011 None
N/A
DALLAS
TX
ACTIVE
4/9/2012 None
N/A
KYLE
TX
ACTIVE
7/16/2010 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/21/2013 None
N/A
6/15/2012 None
11/25/2010 None
N/A
N/A
4/2/2012
7/1/2010
8/15/2013
6/15/2012
11/15/2010
P7639
GORADIA, VIPOOL KIRIT, MD
N6321
6/4/2010
P5367
GORAYA, NIMRIT , MD
GORDON BURROUGHS,
SHERILYN, MD
GORDON, JENNIFER ROSE
SHULTZ, MD
J6468
GORDON, LORI LYNN, MD
4/9/2010
P6170
P5632
GORE, MARIA ODETTE, MD
GORE, MEGHANA SANDEEP, MD
4/12/2013
3/1/2013
N4435
GORMAN, DEITRICK LE ELLEN, DO
11/6/2009
P1314
GORREPATI, NAVAKANTH, MD
11/4/2011
N2093
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
8/15/2013
2/6/2009
2/1/2013
ORTHOPEDIC
8/15/2018 SURGERY
6/4/2015 NEPHROLOGY
TRANSPLANT
2/6/2014 SURGERY
COLON AND RECTAL
4/9/2015 SURGERY
CARDIOVASCULAR
4/12/2018 DISEASES
WACO
TX
ACTIVE
8/5/2013 None
N/A
DALLAS
TX
ACTIVE
7/9/2013 None
N/A
MO
ACTIVE
LICENSE
ISSUED
4/10/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
9/2/2013 None
N/A
6/4/2010 None
N/A
INTERNAL MEDICINE SAINT LOUIS
HUMBLE
TX
INTERNAL MEDICINE
TX
ACTIVE
8/21/2009 None
N/A
TX
ACTIVE
2/11/2013 None
N/A
FORT WORTH TX
ACTIVE
4/20/2010 None
N/A
TX
ACTIVE
ACTIVE
4/17/2013 None
3/6/2013 None
N/A
N/A
TX
ACTIVE
11/24/2009 None
N/A
ACTIVE
11/28/2011 None
N/A
AUSTIN
PECOS
GASTROENTEROLOG
11/4/2016 Y
INTERNAL MEDICINE
Page 99 of 300
License
Number
P2657
Physician Name
GOSPIN, TAL ALON, MD
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRICS,
4/2/2012
4/2/2017 CARDIOLOGY
5/1/2013
HEMATOLOGY
(PATHOLOGY)
Practice City
ACTIVE
4/9/2012 None
N/A
NEW YORK
NY
ACTIVE
5/2/2013 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/26/2010 None
7/8/2013 None
7/21/2011 None
N/A
N/A
N/A
TX
ACTIVE
5/3/2010 None
N/A
OK
3/5/2012 None
N/A
6/4/2010 None
N/A
4/13/2012 None
N/A
6/4/2010 None
8/23/2010 None
N/A
N/A
N5691
P6970
P0391
GOTWAY, GARRETT KENNETH, MD
GOUX, VINCENT PAUL, MD
GOVATHOTI, DEEPTI A, MD
N5693
GOVINDU, RUKMA R, MD
4/9/2010
DALLAS
KINGSLAND
CARTHAGE
WICHITA
FALLS
P2250
GOWANI, JEHANGIR WAZIRALI, MD
3/1/2012
3/1/2017 INTERNAL MED - PEDS SLEEP MEDICINE
DUNCAN
N6322
GOWDA, JEEVAN CHAYTHAN, MD
6/4/2010
P2862
GOWRIGARI, NEELIMA , MD
4/13/2012
N6324
N7268
GOYAL, ABHIJEET, MD
GOYAL, ANUPAMA ASHOK, MD
6/4/2010
8/2/2010
J8252
GOYAL, LALIT, MD
6/1/2012
N9558
GOZHANSKY, DAN, MD
5/2/2011
N4436
GOZMAN, ALEXANDER, MD
11/6/2009
K3211
N3692
GRABER, WILLIAM JAMES IV, MD
GRAHAM, ABRAM KEITH, DO
2/5/2010
8/21/2009
P0726
N6879
P5810
P7450
GRAHAM, BELINDA, MD
GRAHAM, ERIC DUFFEY, MD
GRAHAM, GARY PETER, MD
GRAHAM, PAUL HARDIN, MD
8/15/2011
7/1/2010
3/15/2013
8/1/2013
P5979
GRAHAM, TIMUR TAFARI, MD
4/1/2013
N9559
GRAHAM-CARLSON, AMY DENISE,
MD
5/2/2011
GENETICS
FAMILY PRACTICE
6/4/2015 NEPHROLOGY
INTERNAL MEDICINE
EMERGENCY
6/1/2017 MEDICINE
EMERGENCY
5/2/2016 MEDICINE
PEDIATRIC
HEMATOLOGY/ONCOL
11/6/2014 OGY
2/5/2015 UROLOGY
ALLERGY AND
PULMONARY
CRITICAL CARE
4/1/2018 MEDICINE
Disciplinary
Status Date
TX
GOSWAMI, AARTI, MD
4/9/2015 PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
P6400
4/9/2010
6/14/2013
7/15/2011
5/1/2018 PATHOLOGY
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
DAYTON
OH
ACTIVE
6/11/2012 None
N/A
AUSTIN
TX
ACTIVE
5/20/2011 None
N/A
DALLAS
TX
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
11/11/2009 None
N/A
2/5/2010 None
8/26/2009 None
N/A
N/A
8/18/2011
7/21/2010
4/5/2013
8/5/2013
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
4/3/2013 None
N/A
ACTIVE
5/12/2011 None
N/A
TX
FORT WORTH TX
PLANO
TX
WICHITA
HOUSTON
KS
TX
INTERNAL MEDICINE
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
HOUSTON
Page 100 of 300
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N5081
GRAIR, DIANA , MD
P7640
GRANADOS, HECTOR MANUEL, MD
8/15/2013
P1316
P5634
11/4/2011
3/1/2013
P2252
P7451
GRANDE, KATHRYN BURNS, MD
GRANDHI, JAYASREE, MD
GRANDSTAFF, PHILLIP MATTHEW,
MD
GRANT, WILLIAM NELSON III, MD
N6327
GRAVES, NANCY VICTORIA, MD
N3694
GRAVES, RICHARD MARSHALL, MD
TM00479 GRAY, DANA ANN, MD
N9059
GRAY, ELIZABETH ANNE, MD
H5448
N7233
P2003
GRAY, LAURA ANN, MD
GRAY, MOLLY BROOKS, DO
GRAY, VON PRESTON, MD
P2004
GREAR, BENJAMIN JOPLIN, MD
2/5/2010
3/1/2012
8/1/2013
6/4/2010
8/21/2009
10/17/2011
3/15/2011
11/30/2012
8/2/2010
2/1/2012
2/1/2012
TM00418 GREBENC, MARY LORRAINE, MD
P0980
GRECO, PAUL THOMAS, MD
2/15/2011
9/15/2011
P1079
GREEN, AVAL-NA'REE SIAN, MD
10/3/2011
N6328
GREEN, MICHAEL LINDEN, MD
N6880
P0220
P4572
N5083
GREEN, WALTER LOUIS, MD
GREENE, NOAH HIMES, MD
GREENE, SPENCER COREY, MD
GREENGART, DAVID JONATHAN,
MD
6/4/2010
7/1/2010
7/1/2011
10/1/2012
2/5/2010
PEDIATRIC
OBSTETRICS AND
3/1/2018 NEPHROLOGY
EMERGENCY
3/1/2017 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
EL PASO
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
2/5/2010 None
N/A
ACTIVE
8/20/2013 None
N/A
DALLAS
INTERNAL MEDICINE IRVING
TX
TX
ACTIVE
ACTIVE
12/15/2011 None
3/29/2013 None
N/A
N/A
TAHOKA
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
3/9/2012 None
8/7/2013 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/28/2009 None
N/A
10/17/2011 None
N/A
FT. HOOD
TX
EMERGENCY
10/1/2017 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
Disciplinary
Status Date
TX
6/4/2015 PSYCHIATRY
ORTHOPEDIC
8/21/2014 SURGERY
PHYSICAL MED. &
FOOT AND ANKLE,
DIAGNOSTIC
2/15/2016 RADIOLOGY
PEDIATRIC CRITICAL
EMERGENCY
7/1/2015 MEDICINE
7/1/2016 CARDIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
COLLEGE
STATION
TX
ACTIVE
4/14/2011 None
N/A
TUPELO
DALLAS
MS
TX
ACTIVE
ACTIVE
ACTIVE
12/3/2012 None
8/20/2010 None
2/14/2012 None
N/A
N/A
N/A
DALLAS
TX
2/7/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/15/2011 None
10/11/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
10/5/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
7/13/2010 None
7/8/2011 None
N/A
N/A
ORTHOPEDIC
SURGERY
TEMPLE
EMERGENCY
MEDICAL SERVICES
MEDICAL
TOXICOLOGY
(EMERGENCY
MEDICINE)
Page 101 of 300
ALLEN
NELLIS AFB
HOUSTON
TX
TX
NV
TX
ACTIVE
LICENSE
ISSUED
SEE
PREVIOUS
10/18/2012 ORDER
2/5/2010 None
11/16/2012
N/A
License
Number
P2863
Physician Name
GREENWOOD, NATHANIEL
VROMAN, DO
N5694
GREGG, JAMES PARKER SR, MD
P1759
GREGORY, JANET, DO
N4440
N5695
GREGORY, LINDA , DO
GRETHEL, ERICH JOSEPH, MD
N6882
P6626
GREUTER, AMANDA IRENE, MD
GREWAL, KUSHMIT SINGH, MD
N0805
GREWAL, PREETPAL , DO
P3160
N1658
GRIFFIN, STEPHEN JOHN, MD
GRIFFITH, NATHANIEL LEE, DO
P2120
GRIMM, LEANDER MOREL JR, MD
N8514
GRISEL, JEDIDIAH JAMES, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
EMERGENCY
4/13/2012
4/13/2017 MEDICINE
MEDICAL SERVICES
INTERVENTIONAL
4/9/2010
4/9/2015 RADIOLOGY
RADIOLOGY
EMERGENCY
1/2/2012
1/2/2017 MEDICINE
EMERGENCY
11/6/2009
11/6/2014 MEDICINE
4/9/2010
4/9/2015 PEDIATRIC SURGERY
PEDIATRIC EMER
7/1/2010
7/1/2015 PEDIATRICS
MED (PEDS)
5/15/2013
OBSTETRICS AND
8/29/2008
OBSTETRICS AND
5/15/2012
12/12/2008
2/10/2012
1/18/2011
N7269
GROENING-WANG, MARY TRACI,
DO
8/2/2010
P3335
GRONSTEDT, GARY, DO
6/1/2012
P2994
GROSSMAN, JULIA, MD
5/1/2012
N6331
GROVER, DAVINDER SINGH, MD
6/4/2010
N9866
GROVER, MONICA , MD
6/3/2011
P5636
P1761
GRUBBS, CHRISTINA DANIEL, MD
GU, MELINDA MIN, MD
3/1/2013
1/2/2012
P2253
GU, YING, MD
N3699
GUALANO, SARAH KATHRINE , MD
3/1/2012
8/21/2009
Practice City
ABILENE
Registration
Status of
Practice
Texas
State
License
TX
OBSTETRICS AND
8/2/2015 GYNECOLOGY
6/1/2017 PSYCHIATRY
DIAGNOSTIC
5/1/2017 RADIOLOGY
OPHTHALMOLOGY 6/4/2015 GLAUCOMA
PEDIATRIC
OBSTETRICS AND
3/1/2018 GYNECOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
CHILD AND
ADOLESCENT
PSYCHIATRY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Disciplinary
Status Date
ACTIVE
4/25/2012 None
N/A
ACTIVE
4/30/2010 None
N/A
2/2/2012 None
N/A
11/13/2009 None
4/26/2010 None
N/A
N/A
7/1/2010 None
5/21/2013 None
N/A
N/A
9/5/2008 None
N/A
HOUSTON
TX
ACTIVE
DALLAS
AUSTIN
TX
TX
YUMA
AZ
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
EL PASO
TX
ACTIVE
AMARILLO
EL PASO
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
5/17/2012 None
3/4/2009 None
N/A
N/A
2/10/2012 None
N/A
Registration
Status Date
Disciplinary
Status of
Texas
License
WICHITA
FALLS
TX
ACTIVE
1/26/2011 None
N/A
EL PASO
TX
ACTIVE
8/23/2010 None
N/A
AUSTIN
TX
ACTIVE
6/8/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/7/2012 None
N/A
6/4/2010 None
N/A
6/3/2011 None
N/A
TEMPLE
HOUSTON
TX
TX
ACTIVE
ACTIVE
3/5/2013 None
2/10/2012 None
N/A
N/A
HINES
IL
ACTIVE
3/2/2012 None
N/A
TX
ACTIVE
9/4/2009 None
N/A
Page 102 of 300
License
Number
Physician Name
N7094
GUCE, GARRY MACASAET, MD
N5087
N8009
P1646
P4450
N7427
P6172
N8515
N4443
N9215
GUDIPATY, MADHURI, MD
GUERRA GAROFALO, HECTOR
JUAN, MD
GUERRA VALENCIA, EDUARDO
MIGUEL, MD
GUERRA, CRISTINA, MD
GUERRERO, ROY ANTONY, MD
GUESS, AARON ALAN, DO
GUEVARA, ROBERT , MD
GUILLERMO, CARYL LIZETTE PIGA,
MD
GUILLORY, MARISA NOEL
HOLMES, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2010
OBSTETRICS &
GYNECOLOGICAL
2/5/2010
2/5/2015 SURGERY
10/29/2010
12/15/2011
9/17/2012
8/16/2010
4/12/2013
1/18/2011
EMERGENCY
4/12/2018 MEDICINE
11/6/2009
4/1/2011
12/15/2010
GUILLORY, RYAN MARTIN, MD
PEDIATRIC
P6403
GUIROLA, RICARDO , MD
P6972
P5184
GUJJA, KARTHIK REDDY, MD
GULBIS, ANDREW JOHN, MD
6/14/2013
1/4/2013
N5088
N5696
P4653
GULICK, JENNIFER ROSE, MD
GUMBERT, SAM , MD
GUMMELT, KYLE LAMAR, DO
2/5/2010
4/9/2010
10/15/2012
N3062
GUNGOR, ANIL ABDULLAH, MD
5/29/2009
P1549
12/1/2011
P3336
GUNN, ELAINE E, MD
GUNTIPALLI, PRAVEEN KUMAR,
MD
6/1/2012
P3161
P5638
GUO, MEIHUA , MD
GUPTA, ISHA, MD
5/15/2012
3/1/2013
N1662
GUPTA, JYOTI, MD
12/12/2008
5/15/2017 PATHOLOGY
PEDIATRICS,
Practice City
KAUFMAN
LICENSE
ISSUED
LICENSE
ISSUED
GERIATRICS
GALVESTON
TX
UVALDE
TX
FAMILY MEDICINE
4/1/2016 PEDIATRICS
N8298
5/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
OTOLARYNGIC
ALLERGY
SPORTS MEDICINEPEDS
INTERVENTIONAL
CARDIOLOGY
OBSTETRICS AND
2/5/2015 GYNECOLOGY
OTORHINOLARYNGOL PEDIATRIC
5/29/2014 OGY
OTOLARYNGOLOGY
HOSPITALIST
Page 103 of 300
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/19/2010 None
N/A
2/5/2010 None
N/A
10/29/2010 None
N/A
1/19/2012 None
10/8/2012 None
9/6/2010 None
N/A
N/A
N/A
4/12/2013 None
1/21/2011 None
N/A
N/A
WEBSTER
TX
ACTIVE
11/16/2009 None
N/A
LITTLE ROCK
AR
ACTIVE
4/7/2011 None
N/A
ACTIVE
12/21/2010 None
N/A
5/3/2013 None
N/A
6/14/2013 None
1/7/2013 None
N/A
N/A
2/5/2010 None
5/3/2010 None
10/18/2012 None
N/A
N/A
N/A
HOUSTON
TX
HEMPHILL
TX
HOUSTON
DALLAS
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
TEMPLE
TX
ACTIVE
6/15/2009 None
N/A
BRYAN
TX
ACTIVE
12/5/2011 None
N/A
6/12/2012 None
N/A
PATERSON
NJ
ACTIVE
LICENSE
ISSUED
ACTIVE
5/15/2012 None
4/29/2013 None
N/A
N/A
MCALLEN
TX
ACTIVE
12/30/2008 None
N/A
License
Number
Physician Name
N4446
P5983
P6173
GUPTA, MANU, MD
GUPTA, MOHIT, MD
GUPTA, NISHANT, MD
N6332
P0393
GUPTA, RUCHI, MD
GUPTA, SACHIN, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
PAIN
MANAGEMENT/REHAB
11/6/2009
11/6/2014 MED
FORT MYERS
4/1/2013
INTERNAL MEDICINE UPLAND
4/12/2013
PATERSON
6/4/2010
7/15/2011
6/4/2015 PEDIATRICS
OTOLARYNGOLOGY
6/3/2018 (NEUROTOLOGY)
P6824
GUPTA, SACHIN, MD
6/3/2013
N6333
N6883
GUPTA, SHILPA, DO
GUPTA, SONIKA, MD
6/4/2010
7/1/2010
P7115
P4761
GUPTA, SUNITA NARENDRA, MD
GUPTA, SURESH C, MD
7/1/2013
11/1/2012
P0221
P7771
GUPTA, UMANG, MD
GUPTE, MANJUSHA ARUN, MD
7/1/2011
8/30/2013
INFECTIOUS
7/1/2018 DISEASES
PEDIATRICS,
7/1/2016 CARDIOLOGY
N3704
GUPTHA, SUSHMA NAGARAJ , MD
GUPTON, THEODORE BRYAN JR,
MD
GURURAJ, BHARATH RAJ, MD
8/21/2009
10/1/2010
12/12/2008
10/1/2015 RADIOLOGY
EMERGENCY
5/15/2017 MEDICINE
N7804
N1664
P3163
J5778
GUST, SHANNON KATHLEEN, MD
GUTIERREZ, BERNARDO ALVARO,
MD
P0058
GUTIERREZ, DAVID SIMON, MD
6/15/2011
P2452
GUTIERREZ, JOSE ARMANDO, MD
3/15/2012
P0395
P7277
N8922
P6174
P6404
GUTIERREZ, MARIO A, MD
GUTIERREZ, MICHAEL JOSEPH,
MD
GUTIERREZ, YESENIA FIGUEROA,
DO
GUTIERREZ-MACIAS, RODOLFO
GABRIEL, MD
GUTMAN, JUSTIN, MD
5/15/2012
10/17/2011
TX
OTOLOGY/NEUTOTO
LOGY
DALLAS
TX
INTERNAL MEDICINE
Disciplinary
Status Date
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
12/1/2009 None
4/8/2013 None
4/29/2013 None
N/A
N/A
N/A
6/4/2010 None
7/21/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/5/2013 None
N/A
6/4/2010 None
7/23/2010 None
N/A
N/A
ACTIVE
ACTIVE
7/2/2013 None
11/7/2012 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
7/6/2011 None
9/9/2013 None
N/A
N/A
MIDLAND
TX
ACTIVE
8/27/2009 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
10/11/2010 None
12/29/2008 None
N/A
N/A
ROWLETT
GERIATRICS INTERNAL MEDICINE TEMPLE
TX
ACTIVE
5/29/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
10/18/2011 None
N/A
6/15/2011 None
N/A
ACTIVE
3/23/2012 None
N/A
ACTIVE
7/20/2011 None
N/A
TX
ACTIVE
9/10/2013 None
N/A
FORT WORTH TX
ACTIVE
3/4/2011 None
N/A
ACTIVE
ACTIVE
4/26/2013 None
5/21/2013 None
N/A
N/A
DALLAS
7/15/2013
Registration
Status Date
Disciplinary
Status of
Texas
License
CORPUS
CHRISTI
AUSTIN
PEDIATRICS
HOSPITALIST
TX
NEUROLOGICAL
SURGERY
4/12/2013
5/1/2013
GA
PA
NJ
DALLAS
EMERGENCY
3/15/2017 MEDICINE
7/15/2011
3/1/2011
Registration
Status of
Practice
Texas
State
License
3/1/2016 PEDIATRICS
Page 104 of 300
LAREDO
License
Number
N5092
P6627
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N1665
GUTTENPLAN, MITCHEL , MD
GUZMAN, ALFONSO JR, MD
GUZMAN, CHRISTOPHER
ZIPAGAN, MD
2/5/2010
5/15/2013
P3533
GUZMAN-ABLOG, MYLEEN, MD
P7278
7/15/2013
N5699
GWIN, KATJA, MD
GYVES-RAY, KATHERINE MARY,
MD
4/9/2010
6/8/2017 PEDIATRICS
ANATOMIC
7/15/2018 PATHOLOGY
DIAGNOSTIC
4/9/2015 RADIOLOGY
N7096
HA, LINH THI MY, MD
7/15/2010
12/12/2008
6/8/2012
Secondary Specialty
(Self-Designated)
MCALLEN
DALLAS
P1871
HA, THOA KIM, MD
1/17/2012
OBSTETRICS AND
N7097
P0059
HAAS, ROBERT JUNIUS JR, MD
HAAS, SALLY JASMINE, MD
7/15/2010
6/15/2011
7/15/2015 PATHOLOGY
NEONATOLOGY
N0813
HABIBA, NUSRATH MOHIDEEN, MD
8/29/2008
N9562
HACKER, CALLENDA A, MD
5/2/2011
PEDIATRIC
REHABILITATION
5/2/2016 MEDICINE
P2662
HACKL, THEODORE E, MD
4/2/2012
P4762
HADDADIAN, BABAK, MD
11/1/2012
P2866
HADDOCK, NICHOLAS TILL, MD
4/13/2012
P0595
HAERI, SINA , MD
P1317
HAEUSSLEIN, ERNEST A, MD
11/4/2011
CARDIOVASCULAR
11/1/2017 DISEASES
PLASTIC &
RECONSTRUCTIVE
4/13/2017 SURGERY
MATERNAL AND
CARDIOVASCULAR
11/4/2016 DISEASES
N9060
HAFFORD, MELANIE LYNETTE, MD
3/15/2011
H6263
P4871
HAGER, DAVID CHRISTOPHER, MD
HAGIN, GERALD DOUGLAS, MD
8/29/2008
11/15/2012
11/15/2017 ONCOLOGY
TX
TX
PEDIATRIC
RADIOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
8/1/2011
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
5/20/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
12/17/2008 None
N/A
6/8/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/19/2013 None
N/A
4/9/2010 None
N/A
7/15/2010 None
N/A
2/23/2012 None
N/A
7/15/2010 None
6/21/2011 None
N/A
N/A
DALLAS
RICHARDSON TX
ACTIVE
LICENSE
ISSUED
ACTIVE
FT WORTH
TX
ACTIVE
9/8/2008 None
N/A
DALLAS
TX
ACTIVE
6/16/2011 None
N/A
4/2/2012 None
N/A
OPHTHALMOLOGY ANTERIOR SURGERY
LICENSE
ISSUED
INTERNAL MEDICINE LACROSSE
WI
ACTIVE
11/8/2012 None
N/A
HAND SURGERY
OBSTETRICS AND
GYNECOLOGY
DALLAS
TX
ACTIVE
4/23/2012 None
N/A
HOUSTON
TX
ACTIVE
8/5/2011 None
N/A
ACTIVE
11/7/2011 None
N/A
TX
ACTIVE
3/29/2011 None
N/A
TX
IA
ACTIVE
ACTIVE
10/3/2008 None
12/21/2012 None
N/A
N/A
INTERNAL MEDICINE
DALLAS
FORENSIC
PSYCHIATRY
KERRVILLE
Page 105 of 300
License
Number
Physician Name
P7453
P5371
HAGIWARA, YUYA , MD
HAGOPIAN, TARA , DO
P7454
HAGOS, ELILTA M, MD
P0398
P0728
P0399
HAHN, GIORA, MD
HAIDER, AMAN , MD
HAIDER, HUMA, MD
N6336
P1648
P7772
HAIDER, MUMNOON, MD
HAIDER, NADEEM, MD
HAILE, ISRAEL, MD
P3631
P2005
HAIN, PAUL DOUGLAS, MD
HAIRR, JOHN, MD
P3534
HAJIRAWALA, MITABEN, MD
N7429
N5703
HAJJAR, JOUD , MD
HAKES, JOSEPH D., MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
8/1/2013
MEDICINE
2/1/2013
2/1/2018 RADIOLOGY
NEURO-RADIOLOGY
8/1/2013
7/15/2011
8/15/2011
7/15/2011
6/4/2010
12/15/2011
8/30/2013
6/15/2012
2/1/2012
6/8/2012
8/16/2010
4/9/2010
P6407
HAKIM, HANA, MD
5/1/2013
P0597
HAKIM, VICTOR NABEEL, MD
8/1/2011
N5704
HALABI, SAFWAN SAFAR, MD
4/9/2010
N2103
HALES, NATHAN WAYNE, MD
HALLENBECK, KATHERINE ANN,
TM00493 MD
N3713
P7455
P3166
HAMAKER, JUSTIN CHARLES, MD
HAMBY, RICKEY WHITE JR, MD
HAMDARD, FARAH, MD
N5095
HAMID, STACY ELISE, MD
P3633
HAMILTON, ALAN SCOTT, MD
2/6/2009
12/15/2011
8/21/2009
8/1/2013
5/15/2012
2/5/2010
6/15/2012
Practice City
SIOUX FALLS
Registration
Status of
Practice
Texas
State
License
SD
8/7/2013 None
2/18/2013 None
N/A
N/A
8/1/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/10/2011 None
8/24/2011 None
8/8/2011 None
N/A
N/A
N/A
6/4/2010 None
1/3/2012 None
9/9/2013 None
N/A
N/A
N/A
6/15/2012 None
2/7/2012 None
N/A
N/A
6/8/2012 None
N/A
ACTIVE
ACTIVE
9/6/2010 None
4/27/2010 None
N/A
N/A
5/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
8/31/2011 None
N/A
4/9/2010 None
N/A
SAN ANTONIO TX
ACTIVE
2/12/2009 None
N/A
MILWAUKEE
WI
ACTIVE
12/30/2011 None
N/A
TEMPLE
TX
GRAFTON
WI
ACTIVE
ACTIVE
ACTIVE
CO
TX
TX
FARGO
INTERNAL MEDICINE LIBERTY
ND
TX
HOUSTON
TX
FORT WORTH TX
PEDIATRIC
INFECTIOUS
DISEASE
5/1/2018 PEDIATRICS
ORTHOPEDIC
8/1/2016 SURGERY
DIAGNOSTIC
4/9/2015 RADIOLOGY
OTORHINOLARYNGOL HEAD AND NECK
2/6/2014 OGY
SURGERY
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
PHYSICAL MED. &
BREAST IMAGING
LICENSE
ISSUED
PLANO
TX
FAMILY MEDICINE
ANESTHESIOLOGY
SPINE AND SPORTS
MEDICINE
Page 106 of 300
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
ASPEN
HOUSTON
PALLIATIVE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
N/A
N/A
N/A
LICENSE
ISSUED
8/26/2009 None
8/20/2013 None
6/12/2012 None
UNDER
BOARD
2/5/2010 ORDER
ACTIVE
6/20/2012 None
N/A
12/7/2009
License
Number
Physician Name
P3167
HAMILTON, CARLTON
CARMICHAEL II, MD
HAMILTON, FRANCHELL RICHARD,
MD
N6339
HAMILTON, KALEB MICHAEL, MD
N8010
HAMILTON, RENEE CHRISTINE, MD
HAMILTON, TANISHA JAMARRIA,
MD
L3675
P0401
dicaid
dicaid
Agreement
End Date
Designated)
4/13/2012
EMERGENCY
4/13/2017 MEDICINE
5/15/2012
6/4/2010
10/29/2010
7/15/2011
12/17/2012
TM00532 HAMMER, RICHARD A, MD
12/17/2012
12/17/2012
HAMMO BARAZI, MAHMOUD , MD
10/10/2008
P1320
HAMMOND, GAINES JR, MD
11/4/2011
N3067
HAMNER, CHAD EDWARD , MD
5/29/2009
P1762
HAMZEH, IHAB, MD
P1182
HAN, ANTHONY TAE HYUNG, MD
10/17/2011
N8300
12/15/2010
N4448
P3337
HANA, MICHAEL SHEHATA, MD
HANCHER-HODGES, SHANNON B,
MD
HANCOCK, HEATHER MAY, MD
L4420
HANIF, BASHIR, MD
P0403
HANIF, SYRA, MD
P0598
HANNA, ANGELA MARIE, MD
1/2/2012
11/6/2009
6/1/2012
6/8/2012
7/15/2011
8/1/2011
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
EMERGENCY
10/29/2015 MEDICINE
N1342
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
Practice City
State
License
TEXAS
LICENSE
CLEARWATER FL
ISSUED
AUSTIN
ALBUQUERQU
E
ALBUQUERQU
E
ALBUQUERQU
E
GERIATRIC
MEDICINE (INTERNAL
MED)
HOUSTON
11/4/2016 UROLOGY
WACO
Page 107 of 300
PARIS
4/13/2012 None
N/A
5/29/2012 None
N/A
6/4/2010 None
N/A
10/29/2010 None
N/A
ACTIVE
7/20/2011 None
N/A
NM
ACTIVE
12/21/2012 None
N/A
NM
ACTIVE
12/21/2012 None
N/A
NM
ACTIVE
12/21/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
10/20/2008 None
N/A
11/4/2011 None
N/A
ACTIVE
6/18/2009 None
N/A
ACTIVE
1/16/2012 None
N/A
ACTIVE
LICENSE
ISSUED
11/2/2011 None
N/A
12/15/2010 None
N/A
ACTIVE
ACTIVE
11/30/2009 None
6/7/2012 None
N/A
N/A
6/12/2012 None
N/A
7/15/2011 None
N/A
8/1/2011 None
N/A
TX
SAN ANTONIO TX
INTERVENTIONAL
CARDIOLOGY
Disciplinary
Status Date
TX
5/29/2014 PEDIATRIC SURGERY GENERAL SURGERY FORT WORTH TX
CARDIOVASCULAR
1/2/2017 DISEASES
HOUSTON
TX
ANESTHESIOLOGY 10/17/2016 ANESTHESIOLOGY
PAIN MANAGEMENT EL PASO
TX
ANESTHESIOLOGY
CARDIOVASCULAR
6/8/2017 DISEASES
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PULMONARY
CRITICAL CARE
12/15/2010
12/15/2015 MEDICINE
SLEEP MEDICINE
OBSTETRICS AND
12/12/2008
N8301
HANNA, HALIM, MD
N1669
HANNA, SABRINA ANN, MD
N7098
HANNA-MOUSSA, SHAFIK, MD
7/15/2010
N9061
P1321
HANNAN, RAQUIBUL, MD
HANNON, PAUL JOSEPH III, MD
3/15/2011
11/4/2011
P5373
HANRAHAN, ROBERT, MD
2/1/2013
N9563
HANSCOM, DAVID RAMSEY, DO
5/2/2011
N6342
HANSEN, CATHERINE ANNE, MD
6/4/2010
N7545
HANSEN, JACOB JOSEPH, DO
8/27/2010
N8516
HANSEN, JENNIFER, DO
1/18/2011
N9564
HANSEN, PAUL ADRIAN, MD
N7621
N9710
P0061
HANSEN, THOMAS ERIC, MD
HANSON, ELIZABETH REED, MD
HANSON, JOSHUA THOMAS, MD
9/1/2010
5/16/2011
6/15/2011
P6177
HAPP, ERIN MARIE, DO
4/12/2013
P2995
N0818
HAPPE, SARAH KATHLEEN, MD
HAPPEL, CHRISTOPHER CHARLES,
MD
8/29/2008
P6629
HAQ, OMAR ANWAR, MD
5/15/2013
P3340
HAQUE, WAQAR MOHAMMAD, MD
6/1/2012
N8517
P7117
HARANATH, SAI PRASHANTH, MD
HARCOURT, KAREN AIKO, DO
1/18/2011
7/1/2013
N5707
HARDAWAY, BRIAN WILLIAM, MD
4/9/2010
5/2/2011
5/1/2012
RADIATION
3/15/2016 ONCOLOGY
11/4/2016 RADIOLOGY
EMERGENCY
2/1/2018 MEDICINE
EMERGENCY
5/2/2016 MEDICINE
OBSTETRICS AND
6/4/2015 GYNECOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ROUND ROCK TX
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/15/2010 None
N/A
2/9/2009 None
N/A
7/15/2010 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
3/22/2011 None
11/11/2011 None
N/A
N/A
KALAMAZOO
MADISON
HEIGHTS
MI
ACTIVE
2/15/2013 None
N/A
MI
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/6/2011 None
N/A
6/4/2010 None
N/A
8/27/2010 None
N/A
ACTIVE
1/27/2011 None
N/A
ACTIVE
5/9/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/6/2010 None
5/30/2011 None
6/21/2011 None
N/A
N/A
N/A
4/12/2013 None
N/A
TX
ACTIVE
6/22/2012 None
N/A
WACO
GASTROENTEROLOG
5/15/2018 Y
INTERNAL MEDICINE ATLANTA
RADIATION
6/1/2017 ONCOLOGY
GALVESTON
TX
ACTIVE
9/26/2008 None
N/A
GA
ACTIVE
6/5/2013 None
N/A
TX
ACTIVE
6/7/2012 None
N/A
CT
TX
ACTIVE
ACTIVE
1/21/2011 None
7/9/2013 None
N/A
N/A
TX
ACTIVE
4/19/2010 None
N/A
EMERGENCY
1/18/2016 MEDICINE
5/2/2016 NEUROLOGY
ORTHOPEDIC
9/1/2015 SURGERY
DALLAS
VASCULAR
NEUROLOGY
SAN ANTONIO TX
SAN ANTONIO TX
4/12/2018 RADIOLOGY
OBSTETRICS AND
5/1/2017 GYNECOLOGY
4/9/2015 CARDIOLOGY
TX
DALLAS
HOSPITALIST
STAMFORD
TOMBALL
Page 108 of 300
License
Number
N7099
Physician Name
HARDAWAY, TIFFANY
ETHEREDGE, MD
N7276
HARDEN, WESLEY R III, MD
TM00466 HARDIE, ROBERT CHARLES, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2010
8/2/2010
8/15/2011
ORTHOPEDIC
5/29/2014 SURGERY
5/29/2009
P0405
HARIRI, HOUSSAM YOUSSEF, MD
7/15/2011
N2104
HARJAI, JOGESH KUMAR, MD
2/6/2009
EMERGENCY
2/6/2014 MEDICINE
N6344
6/4/2010
N4451
HARKINS, JAMES PATRICK JR, MD
HARNESS-BRUMLEY, CAYCE
LYNN, MD
N2105
HARO, LUIS HUMBERTO, MD
2/6/2009
N5708
HARPAVAT, SANJIV , MD
4/9/2010
P6178
P7118
N2106
HARRINGTON, KATHERINE
BROOKS, MD
HARRIS, ANDREA DENISE, MD
HARRIS, BRYAN MARK, MD
4/12/2013
7/1/2013
2/6/2009
N7806
HARRIS, JAMES BRENT, MD
10/1/2010
P2006
HARRIS, JEFFREY THEODORE, MD
N4453
HARRIS, JOHN JASON, MD
P3341
HARRIS, MARCUS LAVELLE, MD
P3634
HARRIS, RYAN JED, MD
6/15/2012
P0729
HARRISON, MATTHEW LEE, DO
8/15/2011
P7119
HARROW, JEFFREY ALAN, MD
7/1/2013
11/6/2009
6/1/2012
THORACIC SURGERY
8/15/2016 RADIOLOGY
HARDY, BRIAN THOMAS , MD
2/1/2012
Practice City
N3071
11/6/2009
Secondary Specialty
(Self-Designated)
SURGERY
EMERGENCY
2/6/2014 MEDICINE
PEDIATRIC
GASTROENTEROLOG
4/9/2015 Y
PEDIATRICS
THORACIC
CARDIOVASCULAR
4/12/2018 SURGERY
7/1/2018 PEDIATRICS
HEMATOLOGY
10/1/2015 PATHOLOGY
(PATHOLOGY)
2/1/2017 NEUROLOGY
EMERGENCY
11/6/2014 MEDICINE
EMERGENCY
MEDICAL SERVICES
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/15/2010 None
N/A
8/2/2010 None
N/A
8/15/2011 None
N/A
AUSTIN
TX
ACTIVE
6/10/2009 None
N/A
TEMPLE
TX
ACTIVE
7/20/2011 None
N/A
CONROE
TX
ACTIVE
LICENSE
ISSUED
2/24/2009 None
N/A
6/4/2010 None
N/A
ACTIVE
11/17/2009 None
N/A
ACTIVE
2/17/2009 None
N/A
LICENSE
ISSUED
4/9/2010 None
N/A
LICENSE
ISSUED
ACTIVE
ACTIVE
4/12/2013 None
7/8/2013 None
2/11/2009 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
10/13/2010 None
N/A
2/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
11/24/2009 None
N/A
6/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
6/21/2012 None
N/A
8/15/2011 None
N/A
ACTIVE
8/14/2013 None
N/A
TYLER
TX
LAS CRUCES
DALLAS
NM
TX
TORRANCE
CA
TEXARKANA
EMERGENCY
CAMP
6/15/2017 MEDICINE
LEJEUNE
EMERGENCY
8/15/2016 MEDICINE
GENERAL PRACTICE
EMERGENCY
7/1/2018 MEDICINE
MCKINNEY
Page 109 of 300
TX
NC
TX
License
Number
N2556
P1460
G3936
Physician Name
HARSHBARGER, RAYMOND
JACKSON III, MD
HART, SUZANNE BARBARA, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/3/2009
11/15/2011
8/29/2008
CRANIOFACIAL
4/3/2014 SURGERY
INTERVENTIONAL
Secondary Specialty
(Self-Designated)
PLASTIC &
RECONSTRUCTIVE
SURGERY
CARDIOVASCULAR
DISEASES
PEDIATRICS,
CARDIOLOGY
N8657
HART, TIMOTHY THOMAS, MD
HARTAS, GEORGIOS
ARISTOTELIS, MD
P5987
HARTING, MANDY S, MD
4/1/2013
P5988
HARTING, MATTHEW TIHEN, MD
4/1/2013
N6346
HARTSHORN, CODY JACKSON, MD
6/4/2010
P3342
HARVEY, ADRIAN TIMOTHY, DO
6/1/2012
DERMATOLOGY
CRITICAL CARE
4/1/2018 PEDIATRIC SURGERY (SURGERY)
ORTHOPEDIC
6/4/2015 SURGERY
NEUROLOGICAL
6/1/2017 SURGERY
N5100
HARVEY, CARRIE LYNN, MD
2/5/2010
2/5/2015 RADIOLOGY
2/4/2011
12/15/2011
8/15/2011
5/1/2012
2/4/2016 PEDIATRICS
MOHS
MICROGRAPHIC
4/1/2018 SURGERY
P1649
P0730
P2996
HASAN, SYED NAVED, MD
HASAN, SYED SAMIH, MD
HASHAM, SARAH , MD
P0903
HASLAM, SEAN GREGORY, MD
9/1/2011
5/1/2017 PEDIATRICS
ORTHOPEDIC
9/1/2016 SURGERY
N6347
HASNI, SYED SHAYAN AHMED, MD
6/4/2010
P0831
HASSAN, AIMAN AMIN, MD
8/26/2011
P2455
HASSAN, AMEER ELSAYED, DO
3/15/2012
3/15/2017 NEUROLOGY
P7457
N3074
HASSAN, SYED FAHIM, MD
HASSAN, WALID SAYED
MOHAMED, MD
P2664
HASSID, VICTOR JOSEPH, MD
4/2/2012
P0224
HATAHET, MOHAMAD HAZEM, MD
7/1/2011
8/1/2013
5/29/2009
PLASTIC &
RECONSTRUCTIVE
4/2/2017 SURGERY
SPORTS MEDICINE
(FAMILY PRACTICE)
EMERGENCY
MEDICINE
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
AUSTIN
TX
ACTIVE
ACTIVE
4/8/2009 None
12/5/2011 None
N/A
N/A
DES MOINES
IA
ACTIVE
LICENSE
ISSUED
9/10/2008 None
N/A
2/4/2011 None
N/A
ACTIVE
4/8/2013 None
N/A
ACTIVE
LICENSE
ISSUED
4/8/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/5/2012 None
N/A
2/5/2010 None
N/A
12/19/2011 None
8/29/2011 None
5/9/2012 None
N/A
N/A
N/A
THE
WOODLANDS TX
HOUSTON
HOUSTON
TX
TX
MADISON
TEMPLE
AMARILLO
AL
TX
TX
ACTIVE
ACTIVE
ACTIVE
PLANO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/13/2011 None
N/A
6/4/2010 None
N/A
8/26/2011 None
N/A
ACTIVE
LICENSE
ISSUED
3/28/2012 None
N/A
8/1/2013 None
N/A
ACTIVE
7/6/2009 None
N/A
TX
ACTIVE
4/9/2012 None
N/A
TX
ACTIVE
7/11/2011 None
N/A
HARLINGEN
TX
NEPHROLOGY
CARDIOVASCULAR
DISEASES
Page 110 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
TEMPLE
License
Number
Physician Name
P5278
HATCHER, JEANNE LEIGH, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
1/15/2013
PULMONARY
CRITICAL CARE
5/29/2009
5/29/2014 MEDICINE
SLEEP MEDICINE
DERMATOLOGIC
6/1/2012
SURGERY
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
4/9/2010
4/9/2015 GYNECOLOGY
SURGERY
INFECTIOUS
2/1/2013
2/1/2018 PEDIATRICS
DISEASES
2/1/2013
INTERNAL MEDICINE
N3075
HATEM, CARLO MAJID , MD
P3343
HATTER, ALYN DALE, DO
N5715
P5375
P5376
HATTON, AMANDA , MD
HATZENBUEHLER, LINDSAY ANN,
MD
HAUCK, MICHELLE MARIE, MD
N5716
HAUN-HITA, DEANNA KAYE, MD
4/9/2010
P7458
HAUPTMEIER, CHERIE LINAE, DO
8/1/2013
P6826
N1674
HAWASLY, KINAN, MD
HAWKINS, KARIN NATHALIE, MD
N6885
P0832
HAWKINS, TRONYA NYCHOLL, MD
HAWTHORNE, KRISTEN MICHELLE,
MD
8/26/2011
OBSTETRICS AND
6/3/2018 GYNECOLOGY
OBSTETRICS AND
7/1/2015 GYNECOLOGY
P7776
HAYANGA, JEREMIAH WILLIAM, MD
8/30/2013
N5719
4/9/2010
P4574
P0600
HAYES, BARTLETT HARDING II, MD
HAYES, CHRISTOPHER BARTON,
MD
HAYES, ERIEL WALLACE, MD
10/1/2012
8/1/2011
N4464
HAYES, GREGORY PATRICK, MD
11/6/2009
P4455
P6632
HAYES, JODY COLEMAN, MD
HAYES, MATTHEW , MD
9/17/2012
5/15/2013
P5814
HAYGOOD-KANE, T LYNNE, DO
3/15/2013
N9062
N1345
P4960
HAYNES, ALEX BERNARD, MD
HAYNES, JAMIE LYNN, MD
HAYS, AUGUSTA ELLICE, MD
3/15/2011
10/10/2008
11/30/2012
6/3/2013
12/12/2008
7/1/2010
Registration
Status of
Practice
Texas
Practice City
State
License
SAN ANTONIO TX
ACTIVE
EL PASO
TX
ACTIVE
6/22/2009 None
N/A
LONGVIEW
TX
ACTIVE
6/12/2012 None
N/A
ACTIVE
4/26/2010 None
N/A
2/7/2013 None
2/5/2013 None
N/A
N/A
4/9/2010 None
N/A
8/1/2013 None
N/A
6/3/2013 None
1/7/2009 None
N/A
N/A
7/1/2010 None
N/A
8/26/2011 None
N/A
HOUSTON
TX
ROUND ROCK TX
HOSPITALIST
OPHTHALMOLOGY
FAMILY PRACTICE
8/1/2016 PEDIATRICS
DIAGNOSTIC
9/17/2017 RADIOLOGY
BREAST IMAGING
OBSTETRICS AND
OBSTETRICS AND
GYNECOLOGY
SURGICAL
3/15/2016 ONCOLOGY
GENERAL SURGERY
Page 111 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/31/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ANDREWS
TX
ACTIVE
9/4/2013 None
N/A
HOUSTON
TX
ACTIVE
4/20/2010 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
10/8/2012 None
8/9/2011 None
N/A
N/A
ACTIVE
12/8/2009 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
9/24/2012 None
5/17/2013 None
N/A
N/A
HENDERSON
TX
ACTIVE
3/21/2013 None
N/A
BOSTON
LUBBOCK
MA
TX
ACTIVE
ACTIVE
ACTIVE
3/30/2011 None
10/31/2008 None
12/4/2012 None
N/A
N/A
N/A
License
Number
Physician Name
L1068
N3724
HAYWARD, DAVID REVALL, MD
HE, CHENYIN , MD
P2997
P3535
dicaid
dicaid
Agreement
End Date
Designated)
12/1/2010
8/21/2009
HE, GUOCHENG DAVID, MD
HE, ZENING, MD
5/1/2012
6/8/2012
6/8/2017 ONCOLOGY
N6348
HEALY, JENNIFER MARIE, DO
6/4/2010
N5721
HEAPS, BRIAN RICHARD, MD
4/9/2010
P6414
HEARD, DENNIS J II, DO
5/1/2013
OBSTETRICS AND
4/9/2015 GYNECOLOGY
EMERGENCY
5/1/2018 MEDICINE
N8924
N0825
N8925
HEARDMON, SAMUEL JAVAR, MD
HEATH, KARINA ANNELISE, MD
HEATH, KEVIN ALAN, MD
3/1/2011
8/29/2008
3/1/2011
3/1/2016 PEDIATRICS
3/1/2016 NEPHROLOGY
N5722
HEBSON, CAROLYN BRAY, MD
4/9/2010
N9218
HECOX, SCOTT EDWARD, MD
4/1/2011
N7808
P2257
HECZEY, ANDRAS, MD
HEGDE, JAY NARAYAN, MD
10/1/2010
3/1/2012
P7279
P3344
N9219
HEIBERGER, BRANDON JOE, MD
HEINEN, ALLISON PAIGE, DO
HEINTZ, D DYER, MD
7/15/2013
6/1/2012
4/1/2011
P4575
HEKEREM, KEMKA ONUZEM, MD
10/1/2012
N9375
HELMAN, JOSHUA BENNETT, MD
4/8/2011
N8790
HELMIG, SARA ELIZABETH, MD
P7777
P5377
HELSEL, BRYAN SCOTT, MD
HEMMERICH, JASON, MD
2/15/2011
8/30/2013
2/1/2013
Secondary Specialty
(Self-Designated)
HOSPITALIST
Practice City
MANITOWOC
DALLAS
Registration
Status of
Practice
Texas
State
License
TEXAS
LICENSE
WI
ISSUED
TX
ACTIVE
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/3/2012 None
6/13/2012 None
N/A
N/A
6/4/2010 None
N/A
TX
ACTIVE
4/30/2010 None
N/A
FORT WORTH TX
ACTIVE
5/8/2013 None
N/A
HOUSTON
TRINITY
ACTIVE
ACTIVE
ACTIVE
3/14/2011 None
9/22/2008 None
3/14/2011 None
N/A
N/A
N/A
ACTIVE
4/27/2010 None
N/A
SAN ANTONIO TX
ACTIVE
4/22/2011 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
10/25/2010 None
3/6/2012 None
N/A
N/A
NASSAU BAY
HOUSTON
DALLAS
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/17/2013 None
6/18/2012 None
4/21/2011 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
10/4/2012 None
N/A
4/21/2011 None
N/A
2/15/2011 None
N/A
CA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
8/30/2013 None
2/21/2013 None
N/A
N/A
TX
WI
TX
TX
INTERNAL MEDICINE
CARDIOVASCULAR
SURGERY
Page 112 of 300
Disciplinary
Status Date
12/1/2010 None
10/22/2009 None
GENERAL PRACTICE HOUSTON
INTERNAL MEDICINE WAUSAU
PALLIATIVE
MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
SUGAR LAND
4/1/2016 SURGERY
PEDIATRIC
HEMATOLOGY/ONCOL
10/1/2015 OGY
EMERGENCY
URGENT CARE
7/15/2018 MEDICINE
MEDICINE
4/1/2016 PEDIATRICS
OCCUPATIONAL
FAMILY PRACTICE ENVIRONMENTAL
10/1/2017 EMERGENCY MED
MEDICINE
EMERGENCY
4/8/2016 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN DIEGO
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
2/15/2011
2/15/2016 MEDICINE
N8791
HEMMERT, JONATHAN WYNN, MD
N6887
HENBEST, HEATH SHYLER, DO
7/1/2010
N9220
HENCE, REGINALD DAVID, MD
4/1/2011
8/26/2011
DIAGNOSTIC
7/1/2018 RADIOLOGY
ORTHOPEDIC
8/26/2016 SURGERY
7/15/2010
7/15/2015 NEUROLOGY
P7121
P0833
N7102
HENDERSON, BENJAMIN REID, MD
HENDERSON, CHRISTOPHER EAN,
MD
P1550
HENDLEY, KATIE LEIGHANNE, MD
HENDRIX, CHRISTOPHER KYLE,
DO
HENDRIX, JENNIFER ANN
KOVARIC, DO
P2670
N0827
N4468
P1461
7/1/2013
11/15/2011
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
RADIOLOGY
ORTHOPEDIC
TRAUMA
INTERVENTIONAL
RADIOLOGY
Practice City
TEXARKANA
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
N/A
7/1/2010 None
N/A
4/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
7/10/2013 None
N/A
8/26/2011 None
N/A
HOUSTON
TX
ACTIVE
7/19/2010 None
N/A
PEORIA
IL
ACTIVE
12/7/2011 None
N/A
12/7/2011 None
N/A
4/2/2012 None
10/20/2008 None
N/A
N/A
11/17/2009 None
N/A
6/19/2009 None
N/A
10/29/2010 None
N/A
2/5/2010 None
N/A
PEKIN
IL
HENKE, JEFFREY W, MD
HENNES, MAGDA MAHER, MD
4/2/2012
8/29/2008
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
11/6/2009
EMERGENCY
5/29/2014 MEDICINE
LUMBERTON
NC
ACTIVE
N3080
HENNESSY, MARK EDWARD, MD
HENNESSY, ROBERTO VICTOR,
MD
N8012
HENRIQUEZ, ALFONSO JESUS, MD
N5511
HENRY, DESMOND BRYAN JR, MD
10/29/2010
2/5/2010
P7461
HENRY, MICHAEL DANIEL, MD
8/1/2013
N9873
HENRY, SHELISE MICHELE, MD
HENRY-DACOSTA, NICOLE
DANEEL, DO
6/3/2011
P1184
N9222
N9712
P7462
P0602
HENSLEY, JUSTIN PAUL, MD
HENSLEY, KATHERINE
HAMPSHIRE, MD
HERALD, KAITLIN JEAN, DO
HERATH, PRIYANTHA PUSHPA
KUMARA, MD
10/17/2011
4/1/2011
5/16/2011
8/1/2013
8/1/2011
PEDIATRIC ANES
2/5/2015 (PEDS)
SAN ANTONIO TX
PEDIATRICS
8/1/2018 PEDIATRICS
EMERGENCY
6/3/2016 MEDICINE
OBSTETRICS AND
EMERGENCY
4/1/2016 MEDICINE
8/1/2016 NEUROLOGY
MOVEMENT
DISORDERS
Page 113 of 300
Disciplinary
Status Date
2/15/2011 None
12/1/2011
5/29/2009
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
MOUNT
PLEASANT
TX
ACTIVE
8/7/2013 None
N/A
ROCHELLE
IL
ACTIVE
6/21/2011 None
N/A
LAREDO
CORPUS
CHRISTI
CORPUS
CHRISTI
HOUSTON
TX
ACTIVE
11/10/2011 None
N/A
TX
ACTIVE
4/6/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
5/24/2011 None
9/9/2013 None
N/A
N/A
ROUND ROCK TX
ACTIVE
9/6/2011 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P7646
HEREDIA, JACQUELINE , MD
8/15/2013
P6415
HERLAND, JONATHAN SETH, MD
5/1/2013
N5726
HERMANN, BRUCE FREDERICK,
MD
4/9/2010
N9454
HERMANN, CYNTHIA DEAL, MD
4/15/2011
N5104
HERNANDEZ, ARTURO , MD
PLASTIC &
RECONSTRUCTIVE
4/9/2015 SURGERY
OBSTETRICS AND
P6181
HERNANDEZ, ENRIQUE, MD
4/12/2013
P7280
HERNANDEZ, JENNIFER LORETTE,
MD
7/15/2013
INTERVENTIONAL
PEDIATRIC
ANESTHESIOLOGY
7/15/2018 (PEDS)
7/15/2010
5/1/2013
4/3/2009
N7103
2/5/2010
Secondary Specialty
(Self-Designated)
Practice City
4/28/2010 None
N/A
4/15/2011 None
N/A
2/5/2010 None
N/A
CARDIOVASCULAR
DISEASES
NEW YORK
NY
ACTIVE
4/30/2013 None
N/A
ANESTHESIOLOGY
DALLAS
TX
ACTIVE
7/23/2013 None
N/A
ACTIVE
7/21/2010 None
N/A
TX
ACTIVE
ACTIVE
5/28/2013 None
4/10/2009 None
N/A
N/A
MI
ACTIVE
10/22/2012 None
N/A
TX
ACTIVE
6/4/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
9/17/2008 None
N/A
7/15/2011 None
N/A
8/29/2008
P0406
HERNANDEZ, RYAN JAMES, MD
HERNANDEZ, TRACY JENNIFER,
MD
HERNANDEZ-ZHANG, MARY
CARMEN, MD
7/15/2011
INTERNAL MEDICINE
P3347
P4456
HERRERA, HENRY ROBERT JR, MD
HERRERA, ULYSSES , MD
6/1/2012
9/17/2012
P2672
HESTER, CHRISTIAN CARDELL, MD
HETHERINGTON, KELLY ALICIA,
MD
HEVA-PATHTHINIGE, INDIKA
THARANGANIE, MD
4/2/2012
ALLERGY AND
4/3/2014 IMMUNOLOGY
P5379
4/3/2009
2/1/2013
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
P3346
N2565
5/7/2013 None
TX
HERNANDEZ, MAURILIO, MD
N0829
N/A
DENTON
P4655
DIAGNOSTIC
6/1/2017 RADIOLOGY
8/15/2013 None
ACTIVE
HOSPITALIST
PASASENA
PAW PAW
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
PLANO
NACOGDOCH
HOSPITALIST
ES
6/1/2012
Disciplinary
Status Date
ME
P6416
N2563
Registration
Status Date
Disciplinary
Status of
Texas
License
BANGOR
HERNANDEZ, JUAN ANTONIO, MD
HERNANDEZ, LILIA HORTENCIA,
MD
HERNANDEZ, LUIS FELIPE , DO
10/15/2012
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
OPHTHALMOLOGY
Page 114 of 300
DALLAS
TX
ACTIVE
ACTIVE
6/11/2012 None
10/23/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
4/11/2012 None
N/A
CEDAR PARK
TX
ACTIVE
LICENSE
ISSUED
4/27/2009 None
N/A
2/1/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
DERMATOLOGIC
5/1/2012
5/1/2017 SURGERY
DERMATOLOGY
5/16/2011
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
5/15/2013
SURGERY
PEDIATRIC
2/5/2010
PEDIATRICS
P2999
N9713
HEXSEL FOLK, CAMILE LUIZA, MD
HEY, WAYNE DAVID, DO
P6634
HICE-GARZA, JARMARA
LAURETTE, MD
N5106
HICKS, KELLY ANNE, MD
P0226
N9065
HICKS, WILLIAM JAMES II, MD
HIGGS, SARAH KAY, MD
7/1/2011
3/15/2011
P6182
HILL, AUSTIN D, MD
4/12/2013
7/1/2016 NEUROLOGY
ORTHOPEDIC
4/12/2018 TRAUMA
P6975
HILL, BRANDON ROBERT, MD
6/14/2013
P5816
HILL, CHARLES ARTHUR III, MD
3/15/2013
P4961
HILL, GUYON JAMES, MD
11/30/2012
N5729
HILL, JOSHUA S, MD
4/9/2010
P0904
HILL, SAMANTHA E, MD
9/1/2011
P6635
HILLIER, SHANNON LYNNE, DO
5/15/2013
N8519
HILLS, TINA , DO
N7280
HILMI, JOHN OMAR, MD
P0982
HILTON, LEVI JEFFERSON, MD
9/15/2011
N9224
P0604
HINES, MICHAEL HERBERT, MD
HINH, PETER , MD
4/1/2011
8/1/2011
TM00459 HINKE, DAVID HENRY, MD
P5817
P0407
HINKLE, CHELSEA ELIZABETH, MD
HINOJOSA, ELIAS , MD
1/18/2011
8/2/2010
8/1/2011
3/15/2013
7/15/2011
ORTHOPEDIC
SURGERY
EMERGENCY
11/30/2017 MEDICINE
SURGICAL
4/9/2015 ONCOLOGY
PEDIATRIC
EMERGENCY
1/18/2016 MEDICINE
EMERGENCY
8/2/2015 MEDICINE
EMERGENCY
9/15/2016 MEDICINE
PEDIATRIC
CARDIOTHORACIC
4/1/2016 SURGERY
DERMATOLOGY
EMERGENCY
MEDICAL SERVICES
CARDIOVASCULAR
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
ACTIVE
5/14/2012 None
5/24/2011 None
N/A
N/A
LUBBOCK
6/12/2013 None
N/A
2/5/2010 None
N/A
7/1/2011 None
3/30/2011 None
N/A
N/A
TX
WACO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
AUSTIN
SALT LAKE
CITY
TX
ACTIVE
4/26/2013 None
N/A
UT
ACTIVE
LICENSE
ISSUED
6/25/2013 None
N/A
3/15/2013 None
N/A
FORT SAM
HOUSTON
TX
ACTIVE
12/4/2012 None
N/A
HOUSTON
TX
ACTIVE
4/27/2010 None
N/A
AUSTIN
CORPUS
CHRISTI
TX
ACTIVE
9/6/2011 None
N/A
TX
ACTIVE
5/20/2013 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
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
4/6/2011 None
8/8/2011 None
N/A
N/A
8/1/2011 None
N/A
ACTIVE
3/20/2013 None
N/A
ACTIVE
7/20/2011 None
N/A
HOSPITALIST
Page 115 of 300
Disciplinary
Status Date
HOUSTON
TX
FORT WORTH TX
8/1/2016 RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
CORPUS
CHRISTI
TX
License
Number
Physician Name
N9874
P4459
HIRAKI, STEPHANIE , DO
HIREMATH, ADARSH, MD
P7123
HIRSCH, BENJAMIN AARON, MD
P4657
HITCHCOCK, ROBERT JOHN, MD
P0066
HO, DENNIS , DO
dicaid
dicaid
Agreement
End Date
Designated)
6/3/2011
9/17/2012
7/1/2013
10/15/2012
EMERGENCY
10/15/2017 MEDICINE
6/15/2011
N9456
HO, TONY TRAN, MD
4/15/2011
P6637
HOANG, AMANDA PHAM, MD
5/15/2013
DIAGNOSTIC
5/15/2018 RADIOLOGY
P6638
HOANG, AN NGOC, MD
5/15/2013
5/15/2018 UROLOGY
N6356
P7778
HOANG, TRACY TRAN, DO
HOANG, VU LINH, MD
6/4/2010
8/30/2013
P1082
HODGE, SCOTT DAVID, MD
10/3/2011
P0834
HODGES, KELLY R, MD
8/26/2011
EMERGENCY
10/3/2016 MEDICINE
OBSTETRICS &
GYNECOLOGICAL
8/26/2016 SURGERY
P2261
HODGES, MICHAEL CAMERON, MD
3/1/2012
N6357
HODNETT, GEORGE MICHAEL, MD
6/4/2010
P2673
HOENE, ANDREW JOHN, MD
4/2/2012
P3000
HOFFARTH, KEVIN, MD
N3084
HOFFMAN, KAREN ELIZABETH , MD
5/29/2009
P1764
N3734
HOFFMAN, KEVIN LEE, MD
HOHLT, RUSSELL WADE, MD
HOLCK, DAVID EDWARD EINAR,
MD
1/2/2012
8/21/2009
N3735
5/1/2012
8/21/2009
Secondary Specialty
(Self-Designated)
INTERNAL MEDICINE
CARDIOVASCULAR
SURGERY
7/23/2013 None
N/A
10/22/2012 None
N/A
6/15/2011 None
N/A
4/15/2011 None
N/A
5/17/2013 None
N/A
6/6/2013 None
N/A
6/4/2010 None
9/2/2013 None
N/A
N/A
10/24/2011 None
N/A
LICENSE
ISSUED
8/26/2011 None
N/A
ACTIVE
4/11/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
MANASSAS
VA
ACTIVE
SUGAR LAND
TX
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
AMARILLO
TX
LICENSE
ISSUED
GENERAL
PREVENTIVE
MEDICINE
OPHTHALMOLOGY
Page 116 of 300
Disciplinary
Status Date
N/A
N/A
ACTIVE
OBSTETRICS &
GYNECOLOGICAL
6/4/2015 SURGERY
EMERGENCY
4/2/2017 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
6/3/2011 None
9/19/2012 None
ACTIVE
INFECTIOUS
DISEASES
UROLOGIC
ONCOLOGY
RADIATION
5/29/2014 ONCOLOGY
EMERGENCY
1/2/2017 MEDICINE
OPHTHALMOLOGY 8/21/2014 RECONST SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
AUSTIN
TX
ACTIVE
4/11/2012 None
N/A
LAKEWAY
TX
ACTIVE
5/3/2012 None
N/A
HOUSTON
TX
ACTIVE
6/3/2009 None
N/A
HOUSTON
VICTORIA
TX
TX
ACTIVE
ACTIVE
1/4/2012 None
9/15/2009 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
8/31/2009 None
N/A
License
Number
P5534
Physician Name
N0837
HOLLAND, COURTNEY ALLEN, MD
N9376
HOLLAND, DANNY CARL, DO
4/8/2011
N6359
HOLLAND, MARTIN CARLOS, MD
6/4/2010
ORTHOPEDIC
8/29/2013 SURGERY
ORTHOPEDIC
4/8/2016 TRAUMA
NEUROLOGICAL
6/4/2015 SURGERY
P5380
HOLLER-MANAGAN, YOLANDA, MD
2/1/2013
N6360
P6419
HOLDER, JIMMY LLOYD JR, MD
dicaid
dicaid
Agreement
End Date
Designated)
HOLLINGSWORTH, AMANDA, DO
HOLLINGWORTH, DANIELLE
MARIE, MD
2/8/2013
8/29/2008
6/4/2010
5/1/2013
P5535
HOLLSTEN, JORDAN ENID, MD
2/8/2013
P3002
HOLMES, AMIE ELIZABETH, MD
5/1/2012
P1765
N9377
HOLT, OLAYINKA OMOWUNMI, MD
HOLT, SHEA RYAN, MD
1/2/2012
4/8/2011
N7547
HOMMEL, ERIN LEIGH, MD
N5731
HONDA, KORD, MD
N1682
HONG, MAURICIO FEDERICO, MD
P7465
HONG, ROBERT, MD
8/1/2013
P0228
HONTZ, BLAIR, DO
7/1/2011
P6977
HOOD, BRIAN JAMES, MD
8/27/2010
4/9/2010
12/12/2008
6/14/2013
OBSTETRICS AND
6/4/2015 GYNECOLOGY
EMERGENCY
5/1/2018 MEDICINE
OBSTETRICS AND
5/1/2017 GYNECOLOGY
4/8/2016 NEPHROLOGY
GERIATRIC MEDICINE
DERMATOPATHOLOG
4/9/2015 Y
CARDIAC
ELECTROPHYSIOLOG
12/12/2013 Y
EMERGENCY
8/1/2018 MEDICINE
EMERGENCY
7/1/2016 MEDICINE
NEUROLOGICAL
6/14/2018 SURGERY
Secondary Specialty
(Self-Designated)
ORTHOPEDIC
TRAUMA
ORTHOPEDIC
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/8/2013 None
N/A
EL PASO
TX
ACTIVE
9/15/2008 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
4/15/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
2/5/2013 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
ACTIVE
5/24/2013 None
N/A
SAN ANTONIO TX
ACTIVE
2/27/2013 None
N/A
GENERAL PRACTICE FORT WORTH TX
ACTIVE
5/11/2012 None
N/A
NEPHROLOGY
ACTIVE
ACTIVE
1/9/2012 None
4/14/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
9/6/2010 None
N/A
4/9/2010 None
N/A
ACTIVE
12/30/2008 None
N/A
ACTIVE
8/5/2013 None
N/A
7/27/2011 None
N/A
6/14/2013 None
N/A
4/1/2013 None
N/A
2/5/2010 None
N/A
OBSTETRICS &
GYNECOLOGICAL
SURGERY
PLASTIC SURGERY
WITHIN THE HEAD
AND NECK
CARDIOLOGY
URGENT CARE
MEDICINE
CLEVELAND
EL PASO
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
P5993
HOODA, BARKAT SADRUDDIN, MD
4/1/2013
4/1/2018 PEDIATRICS
N5111
HOOVER, ANNETTE LARIE, MD
2/5/2010
Page 117 of 300
TX
OH
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
N8405
Physician Name
HOOVER, JASON MARSHALL
THOMAS, MD
HOQUE, MOHAMMED NASEEMUL,
MD
N8192
P1875
HORD, ALLEN HENRY, MD
HOREISH, ADAM, MD
N9567
N7281
P2459
HORN, BRETT W, MD
HORN, RANDAL J, MD
HORNER, JOHN GASTON, MD
G4232
HOROWITZ, SUSAN AMY, MD
P0835
HORRALL, SHAWN DANIEL, MD
P6641
dicaid
dicaid
Agreement
End Date
Designated)
NEUROLOGICAL
5/15/2013
5/15/2018 SURGERY
GASTROENTEROLOG
1/3/2011
1/3/2016 Y
1/17/2012
EMERGENCY
5/2/2011
5/2/2016 MEDICINE
8/2/2010
3/15/2012
ANATOMIC/CLINICAL
1/17/2012
1/17/2017 PATHOLOGY
EMERGENCY
8/26/2011
8/26/2016 MEDICINE
ORTHOPEDIC
4/1/2013
4/1/2018 SURGERY
P5994
HORTON, JOSEPH, MD
N4480
11/6/2009
P6642
P3004
HOSKINS, JOHN, MD
HOTCHKISS, WILLIAM RICHARD,
MD
HOU, JACK CHENG-TSUNG, MD
P3350
HOUGH, SCOTT MATTHEW, MD
6/1/2012
P7466
HOUSER, JOSHUA L, MD
8/1/2013
N5113
HOUSEWRIGHT, CHAD DAVID, MD
2/5/2010
N6888
N9227
HOUSTON, LAURA MARIE, MD
HOWARD, DREW DAVID, MD
7/1/2010
4/1/2011
N7705
HOWARD, TANYA DAYELL, MD
9/15/2010
P5645
HOWELL, AMBER , MD
3/1/2013
N8664
HOWELL, LEE ANN, MD
2/4/2011
P6643
HRANJEC, TJASA, MD
P4965
HSIEH, JOSEPH CHIA-YU, MD
5/15/2013
5/1/2012
5/15/2013
11/30/2012
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
BRYAN
TX
THE
INTERNAL MEDICINE WOODLANDS TX
ACTIVE
5/23/2013 None
N/A
ACTIVE
1/31/2011 None
N/A
ANESTHESIOLOGY
ATLANTA
GILBERT
GA
AZ
ACTIVE
ACTIVE
1/14/2011 None
1/31/2012 None
N/A
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
5/5/2011 None
8/5/2010 None
3/20/2012 None
N/A
N/A
N/A
CYTOPATHOLOGY
AMARILLO
PALESTINE
COLEMAN
POMPANO
BEACH
FL
ACTIVE
1/25/2012 None
N/A
TEMPLE
ALAMOGORD
O
TX
ACTIVE
8/31/2011 None
N/A
NM
ACTIVE
LICENSE
ISSUED
4/3/2013 None
N/A
11/6/2009 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/17/2013 None
5/3/2012 None
N/A
N/A
6/1/2012 None
N/A
8/5/2013 None
N/A
2/5/2010 None
N/A
ORTHOPEDIC
5/15/2018 SURGERY
5/1/2017 UROLOGIC SURGERY UROGYNECOLOGY
EMERGENCY
6/1/2017 MEDICINE
EMERGENCY
8/1/2018 MEDICINE
DERMATOLOGIC
SURGERY
OBSTETRICS AND
7/1/2015 GYNECOLOGY
EMERGENCY
9/15/2015 MEDICINE
EMERGENCY
3/1/2018 MEDICINE
FAMILY PRACTICE
SURGICAL CRITICAL
TRAUMATIC
5/15/2018 CARE
SURGERY
NEUROLOGICAL
11/30/2017 SURGERY
Page 118 of 300
DALLAS
DALLAS
TX
TX
TEMPLE
TX
LIVINGSTON
TX
ACTIVE
LICENSE
ISSUED
CONROE
WICHITA
FALLS
TX
ACTIVE
ACTIVE
7/12/2010 None
4/28/2011 None
N/A
N/A
TX
ACTIVE
10/15/2010 None
N/A
TEMPLE
TX
ACTIVE
4/10/2013 None
N/A
CEDARTOWN GA
ACTIVE
2/15/2011 None
N/A
DALLAS
ACTIVE
LICENSE
ISSUED
5/17/2013 None
N/A
11/30/2012 None
N/A
TX
License
Number
Physician Name
N7106
HSING, JEFF MINDY, MD
P7468
HU, MELISSA, MD
P6979
HU, SHIMIN, MD
N7107
P7783
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CARDIAC
ELECTROPHYSIOLOG ELECTROPHYSIOLO
7/15/2010
7/15/2015 Y
GY
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
Disciplinary
Status Date
7/19/2010 None
N/A
8/1/2013 None
N/A
6/14/2013
OTORHINOLARYNGOL OTOLARYN & FACIAL
8/1/2018 OGY
PLASTIC SURGERY
HEMATOLOGY
6/14/2018 PATHOLOGY
(PATHOLOGY)
HOUSTON
TX
ACTIVE
6/21/2013 None
N/A
HUAMAN VARGAS, GONZALO, MD
7/15/2010
TX
7/20/2010 None
N/A
HUANG, CHRISTINE, MD
8/30/2013
ACTIVE
LICENSE
ISSUED
8/30/2013 None
N/A
8/1/2013
N0842
P6423
N7283
HUANG, CONWAY CANHUI, MD
HUANG, HAOJIANG, MD
HUANG, QIN , MD
8/29/2008
5/1/2013
8/2/2010
P0230
N8931
N9458
HUANG, STEVEN, MD
HUBBARD, BRADLEY ALAN, MD
HUBBLE, LEVI LEWIS, MD
7/1/2011
3/1/2011
4/15/2011
N6364
HUBER, JAY R, DO
6/4/2010
N5115
HUBMER, THOMAS CARL, DO
2/5/2010
N4481
P6424
HUDGINS, CHANNON TERIA , MD
HUH, BILLY KEON, MD
N6366
HUI, SHIU-KI ROCKY, MD
P7470
N3741
11/6/2009
5/1/2013
5/1/2018 PSYCHIATRY
INTERVENTIONAL
7/1/2016 RADIOLOGY
EMERGENCY
2/5/2015 MEDICINE
OBSTETRICS &
GYNECOLOGICAL
11/6/2014 SURGERY
INTERNAL MEDICINE HUMBLE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
GASTROENTEROLOG
Y
AUSTIN
LOUISVILLE
MANSFIELD
TX
KY
TX
ACTIVE
ACTIVE
ACTIVE
9/5/2008 None
7/5/2013 None
8/16/2010 None
N/A
N/A
N/A
RADIOLOGY
HOUSTON
TX
TEMPLE
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/18/2011 None
3/14/2011 None
4/21/2011 None
N/A
N/A
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
12/14/2009 None
5/8/2013 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
8/12/2013 None
9/2/2009 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/23/2011 None
7/6/2011 None
N/A
N/A
8/15/2011 None
N/A
FAMILY PRACTICE
ROCKWALL
PAIN MANAGEMENT HOUSTON
BLOOD
BANKING/TRANSFUSI
CLINICAL PATHOLOGY ON MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
INTERNAL MEDICINE
TEMPLE
PAIN
MANAGEMENT/REHAB
MED
DERMATOLOGY
HOUSTON
6/4/2010
6/4/2015
HUIZAR, ISHAM ALEJANDRO, MD
HULL, JOSHUA , MD
8/1/2013
8/21/2009
8/1/2018
8/21/2014
P0733
P0231
HUME, JOHN WESTMORELAND,
MD
HUNT, CHRISTINE M, MD
8/15/2011
7/1/2011
8/15/2016
7/1/2016
P0735
HUNT, LISA MARGUERITE, MD
8/15/2011
Page 119 of 300
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
11/15/2012
11/15/2017 SURGERY
SURGERY
6/14/2013
3/15/2013
P4872
P6980
P5818
HUNT, THOMAS R III, MD
HUNTER, GRANT, DO
HURLBURT, BRIAN SCOTT, MD
N5737
P6187
HURST, DAVID GREIG , MD
HURT, MYERS ROBINSON III, MD
N6367
HUSAIN, NISREEN, MD
N3745
N0844
HUSAIN, TAMEEM SIRAJ, DO
HUSSAIN, RAHAT, MD
P5189
HUSSAIN, SHABBIR, MD
1/4/2013
P2678
HUSSAIN, YESSAR M, MD
4/2/2012
N1350
HUSSAINI, AKBAR ALY, MD
N7435
HUSSEIN, MOHAMED A W, MD
P1768
HUSTAK, ERIK CHRISTOPHER, MD
N1351
4/9/2010
4/12/2013
6/4/2010
8/21/2009
8/29/2008
10/10/2008
EMERGENCY
4/9/2015 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
4/2/2017 NEUROLOGY
ORTHOPEDIC
10/10/2013 SURGERY
PEDIATRIC
OPHTHALMOLOGY
8/16/2010
1/2/2012
HUTCHINS, MICHAEL WAYNE, MD
10/10/2008
P3352
P5646
P3353
HUYNH, PHUONG NAM-THUY, MD
HUYNH, SUSAN LYNN, DO
HUYNH, TAI T, MD
6/1/2012
3/1/2013
6/1/2012
P5537
HWANG, BECKY JUNGSUN, DO
2/8/2013
P6189
HWANG, YOO JOO, DO
P3354
HYDE, KELLY VAUGHAN, MD
P7284
N6371
4/12/2013
HOSPITALIST
NEUROMUSCULAR
DISEASE
6/1/2017 SPORTS MEDICINE
FAMILY MEDICINE
PEDIATRIC
RADIOLOGY
2/8/2018 RADIOLOGY
EMERGENCY
4/12/2018 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
NORWICH
BEAUMONT
TX
CT
TX
ACTIVE
ACTIVE
ACTIVE
WACO
GALVESTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
AUSTIN
HOUSTON
TX
TX
HYLTON, ALECIA ROSEMARIE, MD
7/15/2013
HYNGSTROM, JOHN ROBERT, MD
6/4/2010
SURGICAL
6/4/2015 ONCOLOGY
GENERAL SURGERY
Page 120 of 300
11/20/2012 None
6/17/2013 None
3/27/2013 None
SEE
PREVIOUS
4/16/2010 ORDER
4/22/2013 None
Disciplinary
Status Date
N/A
N/A
N/A
4/12/2010
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
9/18/2009 None
9/26/2008 None
N/A
N/A
ACTIVE
1/16/2013 None
N/A
AUSTIN
TX
ACTIVE
4/18/2012 None
N/A
AUSTIN
TX
ACTIVE
10/24/2008 None
N/A
HOUSTON
TX
ACTIVE
8/19/2010 None
N/A
GALVESTON
TX
ACTIVE
2/24/2012 None
N/A
SAN ANTONIO TX
ACTIVE
11/17/2008 None
N/A
CLEVELAND
DALLAS
OH
TX
ACTIVE
ACTIVE
ACTIVE
6/13/2012 None
3/6/2013 None
6/25/2012 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
2/18/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/22/2013 None
N/A
6/1/2012 None
N/A
7/15/2013 None
N/A
6/4/2010 None
N/A
6/1/2012
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
N5118
P2009
IANOV, IGOR, MD
IBARRA, JOHN ISIDRO, MD
P7650
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
2/5/2010
2/1/2012
8/15/2013
P0905
IBARRA, RAFAEL ANDRES, MD
IBE, CHIMKAMA NGOZI CYNTHIA,
MD
P7786
IBIDAPO-OBE, OYETOKUNBO, MD
8/30/2013
P1330
IBRAHIM, AALAMGEER KHAKAN,
MD
P2680
IBRAHIM, ALI DHIA, MD
4/2/2012
INDIANAPOLIS IN
P2681
N8406
IBRAHIM, PARISA, MD
ICHO, NANETTE ARIAYEFAH, MD
4/2/2012
1/3/2011
INDIANAPOLIS IN
GARLAND
TX
P6000
P4873
P4874
IDAHOSA, VICTOR OMAMODE, MD
IDOWU, OLAKUNLE, MD
IDOWU, TECHECIA TAMARA, MD
4/1/2013
11/15/2012
11/15/2012
N9878
P1085
6/3/2011
10/3/2011
P6428
IDRIS, MOHAMED HUSSEIN, MD
IDRIZI, HANEME , MD
IFAFORE, ADEBOLA TEMITOPE,
MD
IGBOKWE, EBERENNE FRANCINE,
DO
PEDIATRIC
EMERGENCY
11/30/2017 MEDICINE
N6374
N0846
IGNATIUS, JASMIN ANN, DO
IGUH, BERNADETTE UCHE, MD
P3006
5/1/2012
5/1/2017 PEDIATRICS
P3355
IHEKWEAZU, FAITH DORSEY, MD
IHEUKWUMERE, ESTHER
ORIEAKU, MD
6/1/2012
6/1/2017 NEPHROLOGY
N5120
IKBAL, KATRINY ANN, DO
2/5/2010
N6375
IKEDA, MARCOS HIROSHI, MD
6/4/2010
P4966
P1462
IKHISEMOJIE, AUGUSTA UAYE, MD
9/1/2011
11/4/2011
11/30/2012
HOUSTON
5/1/2013
6/4/2010
8/29/2008
11/15/2011
Disciplinary
Status Date
2/5/2010 None
2/3/2012 None
N/A
N/A
8/15/2013 None
N/A
TX
ACTIVE
9/29/2011 None
N/A
SAN ANTONIO TX
ACTIVE
9/4/2013 None
N/A
11/4/2011 None
N/A
ACTIVE
4/9/2012 None
N/A
ACTIVE
ACTIVE
4/10/2012 None
1/6/2011 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
4/22/2013 None
11/20/2012 None
11/19/2012 None
N/A
N/A
N/A
6/3/2011 None
10/11/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
12/12/2012 None
N/A
5/1/2013 None
N/A
6/4/2010 None
10/7/2008 None
N/A
N/A
CHILD AND
ADOLESCENT
PSYCHIATRY
LICENSE
ISSUED
BROOKLYN
IA
NY
PEDIATRIC
ENDOCRINOLOGY
SAN ANTONIO TX
FAMILY PRACTICE
FAMILY
PRACTICE/OMM
FAMILY PRACTICE
HOUSTON
INTERNAL MEDICINE PARIS
OBSTETRICS AND
6/4/2015 GYNECOLOGY
FAMILY MEDICINE
Page 121 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
GRAND
PRAIRIE
TX
ACTIVE
5/11/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/20/2012 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
12/5/2011 None
N/A
TX
License
Number
Physician Name
N5122
ILASI, JOSEPH ANTHONY , DO
P1654
ILIEV, DESSISLAVA DIMITROVA,
MD
N8306
P3356
P7285
P3172
ILIEV, PETER BRATOVANOV, MD
ILOCHONWU, IKECHUKWU
CHRISTIAN, MD
ILYAS, MUZNA ATIF, MD
IM, JIN SEON , MD
N5123
N8932
dicaid
dicaid
Agreement
End Date
Designated)
2/5/2010
Secondary Specialty
(Self-Designated)
Practice City
2/5/2015 PATHOLOGY
12/15/2011
12/15/2010
6/1/2012
7/15/2013
5/15/2012
IMAM, SYED ATHER, MD
IMANPOUR, JAFAR, MD
2/5/2010
3/1/2011
P0906
IMAS, FRANK, MD
9/1/2011
P6832
P6429
N9072
IMGRUND, KATHRYN HAWKINS,
MD
IMIERE, EDWIN OLATUNJI, MD
IMTIAZ, BATOOL, MD
6/3/2013
5/1/2013
3/15/2011
N0847
IMUNDO, JASON RYAN, MD
8/29/2008
N4492
INGLE, DAVID J, DO
11/6/2009
OBSTETRICS AND
6/3/2018 GYNECOLOGY
PEDIATRICS,
DIAGNOSTIC
11/6/2014 RADIOLOGY
N7436
INGRAM, HOLLY RUDIN, DO
8/16/2010
P2873
N4493
4/13/2012
11/6/2009
P7286
INGRAM, JELANI D, MD
INTODY, ZSOFIA , MD
IOSELEVICH, VADIM BORISOVICH,
MD
7/15/2013
P3007
P7128
IQBAL, MOHAMMED S, MD
IQBAL, NADIA WASI, MD
5/1/2012
7/1/2013
N2576
P5648
IQBAL, SAYEED NURUL, MD
IQBAL, ZOHA , MD
4/3/2009
3/1/2013
P7129
IRELAND, RHIANA, MD
7/1/2013
7/1/2018 NEPHROLOGY
OBSTETRICS AND
4/3/2014 GYNECOLOGY
EMERGENCY
7/1/2018 MEDICINE
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
SLEEPY
HOLLOW
KINGWOOD
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
NY
TX
HOSPITALIST
OBSTETRICS &
GYNECOLOGICAL
SURGERY
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
1/23/2012 None
N/A
12/15/2010 None
N/A
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
MARYSVILLE
OH
ACTIVE
9/8/2011 None
N/A
GERIATRICS
TYLER
LUBBOCK
DALLAS
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
6/21/2013 None
5/6/2013 None
4/20/2011 None
N/A
N/A
N/A
PEDIATRICS
DALLAS
TX
ACTIVE
9/8/2008 None
N/A
ACTIVE
LICENSE
ISSUED
2/4/2010 None
N/A
8/16/2010 None
N/A
KANSAS CITY MO
FAMILY MEDICINE
HOUSTON
HOUSTON
INTERNAL MED PEDS
INTERNAL MEDICINE
Page 122 of 300
TX
TX
ACTIVE
ACTIVE
4/17/2012 None
11/17/2009 None
N/A
N/A
TX
ACTIVE
7/24/2013 None
N/A
ACTIVE
ACTIVE
6/18/2012 None
7/15/2013 None
N/A
N/A
CHICAGO
TEXARKANA
IL
AR
ACTIVE
ACTIVE
5/8/2009 None
3/11/2013 None
N/A
N/A
LONGVIEW
TX
ACTIVE
7/17/2013 None
N/A
License
Number
N9569
N4494
Physician Name
IRIBARREN, JUAN BAUTISTA, MD
IRVINE-MOORE, LAPONNA RAE,
DO
dicaid
dicaid
Agreement
End Date
Designated)
5/2/2011
11/6/2009
FAMILY
P4580
ISAACSON, TERAH C, MD
10/1/2012
N7112
ISACHIEVICI, DIANA , MD
7/15/2010
N6377
ISIGUZO, MANICA, MD
ISKRENKO, ALEXANDER
VLADIMIROVICH, MD
ISLAM, MAHMUDA, MD
6/4/2010
PULMONARY
CRITICAL CARE
6/4/2015 MEDICINE
N7285
P2683
P7287
P5649
ISLAM, MAHMUDA, MD
ISMAAEL, THAYER GELIL KHALIL,
MD
8/2/2010
4/2/2012
7/15/2013
3/1/2013
N0849
ISSA, HUSAM ISMAIL, MD
8/29/2008
N6379
ISSAC, TIM THOMAS, MD
6/4/2010
N7706
ITKIN, PHILIP GAIL, MD
N6380
IVAN, DANIEL LUCIAN, MD
6/4/2010
6/4/2015 PEDIATRICS
N6381
IVAN, MIHAELA CRISTINA, MD
6/4/2010
N9880
IVY, AMANDA MICHELLE, MD
6/3/2011
N6382
IWALOYE, FEMI DAVID, MD
6/4/2010
P7787
IYANAGA, MASAYUKI, MD
8/30/2013
N6383
IYENGAR, PUNEETH , MD
6/4/2010
N9379
IYER, CHITRA, MD
IZNAOLA ESQUIVEL, OSCAR
ALBERTO, MD
4/8/2011
2/6/2009
Practice City
HOUSTON
TX
COLON AND RECTAL
SURGERY
HOSPITALIST
FAMILY PRACTICE
SAN ANTONIO TX
WICHITA
FALLS
INFECTIOUS
DISEASES
NASSAU BAY
TX
TX
6/4/2015 PSYCHIATRY
ORTHOPEDIC
6/3/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
6/4/2015 SURGERY
EMERGENCY
8/30/2018 MEDICINE
RADIATION
6/4/2015 ONCOLOGY
MATERNAL AND
ADOLESCENT
MEDICINE - PD
OMAHA
NE
INTERNAL MEDICINE
SPORTS MEDICINE
(ORTH SURG)
SAN MARCOS TX
OBSTETRICS AND
GYNECOLOGY
Page 123 of 300
EL PASO
TX
Disciplinary
Status Date
5/5/2011 None
N/A
ACTIVE
1/7/2010 None
N/A
11/5/2012 None
N/A
7/15/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
8/9/2010 None
4/13/2012 None
N/A
N/A
ACTIVE
7/17/2013 None
N/A
ACTIVE
3/5/2013 None
N/A
ACTIVE
LICENSE
ISSUED
9/5/2008 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/4/2010 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
6/13/2011 None
N/A
6/4/2010 None
N/A
8/30/2013 None
N/A
6/4/2010 None
N/A
LICENSE
ISSUED
INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
6/4/2015 CARDIOLOGY
9/15/2010
N2126
Secondary Specialty
(Self-Designated)
PULMONARY
MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
BOSTON
MA
ACTIVE
4/26/2011 None
N/A
BEEVILLE
TX
ACTIVE
3/20/2009 None
N/A
License
Number
P1770
P3008
Physician Name
IZQUIERDO, MIGUEL ARMANDO,
MD
JABSHETTY, SANGMESH, MD
P2125
JACKSON, DANIELLE, MD
J6499
dicaid
dicaid
Agreement
End Date
Designated)
1/2/2012
5/1/2012
2/10/2012
EMERGENCY
2/10/2017 MEDICINE
JACKSON, GEORGE ROBERT, MD
6/4/2010
6/4/2015 NEUROLOGY
N5125
JACKSON, LAWSON ALAN JR, MD
2/5/2010
2/5/2015 RADIOLOGY
L6075
JACKSON, MARK R, MD
12/15/2010
P4461
JACKSON, MASHEIKA SHONTAE,
DO
P5383
JACKSON, PAUL MCLEAN, MD
N3094
P0411
JACKSON, RICHARD JEFFREY, MD
JACKSON, SIMONA, MD
P5385
JACKSON, TIFFANY RHEA, MD
N8407
N1691
JACKSON-VANCE, SARA ANN, MD
JACOB, CINDY SARA, MD
P7288
JACOB, ROY GEORGE, MD
7/15/2013
N7548
P3357
JACOB, SHUSHAN, MD
JACOB, SURAJ, MD
8/27/2010
6/1/2012
N0855
JACOBSON, BRADLEY ELLIS, MD
8/29/2008
N2578
JACOBSON, GREGORY H, MD
JACOBSON, TATIANA BORISOVNA
, MD
JADAV, DIP SURESHKUMAR, MD
JADEGONDANAHALLI, JAI
PRAKASH BABU THIPPAIAH, MD
N5127
P6649
N7286
9/17/2012
2/1/2013
5/29/2009
7/15/2011
2/1/2013
1/3/2011
12/12/2008
4/3/2009
2/5/2010
5/15/2013
8/2/2010
Secondary Specialty
(Self-Designated)
HOUSTON
TX
ACTIVE
ACTIVE
AUSTIN
TX
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
HOSPITALIST
PEDIATRIC
RADIOLOGY
EMERGENCY
12/15/2015 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
TOOELE
UT
FT. WORTH
TX
2/1/2018 RADIOLOGY
OBSTETRICS AND
GYNECOLOGIC
2/1/2018 GYNECOLOGY
SURGERY
EMERGENCY
1/3/2016 MEDICINE
OBSTETRICS
DIAGNOSTIC
7/15/2018 NEURO-RADIOLOGY
RADIOLOGY
HAND SURGERY 8/27/2015 SURGERY
EMERGENCY
8/29/2013 MEDICINE
EMERGENCY
4/3/2014 MEDICINE
Page 124 of 300
ACTIVE
LICENSE
ISSUED
FORT WORTH TX
ACTIVE
ACTIVE
CELEBRATION FL
Registration
Status Date
Disciplinary
Status of
Texas
License
1/3/2012 None
6/6/2012 None
SEE
PREVIOUS
2/14/2012 ORDER
Disciplinary
Status Date
N/A
N/A
2/13/2012
6/4/2010 None
N/A
2/5/2010 None
N/A
12/15/2010 None
N/A
11/16/2012 None
N/A
2/1/2013 None
N/A
7/7/2009 None
8/22/2011 None
N/A
N/A
2/5/2013 None
N/A
1/3/2011 None
12/19/2008 None
N/A
N/A
VICTORIA
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
7/17/2013 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
9/6/2010 None
6/11/2012 None
N/A
N/A
ACTIVE
9/5/2008 None
N/A
4/15/2009 None
N/A
2/5/2010 None
5/20/2013 None
N/A
N/A
9/17/2010 None
N/A
SUGAR LAND
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ODESSA
TX
ACTIVE
License
Number
Physician Name
P0412
JAFFER, SALIMA , MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2011
CARDIOINTERVENTIONAL
12/17/2012
12/17/2012
12/17/2012
NEUROLOGY &
12/1/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
P5086
JAFFRANI, WASEEM MUHAMMAD,
MD
P5086
MD
P5086
MD
N8196
JAFFRI, MOSSADIQ S, MD
N4495
JAFRI, AHMED HASSAN, MD
11/6/2009
N0857
JAFRI, NADIM SYED, MD
P2127
JAFRI, SYED FARRUKH HASAN, MD
P3542
JAFRI, SYED RAZA ABBAS, MD
P5087
JAGARLAMUDI, ANNAPURNA, MD
12/17/2012
INTERNAL MEDICINE GALLIPOLIS
OH
P5087
12/17/2012
P5087
12/17/2012
P0413
JAGLOWSKI, JEFFREY ROBERT,
MD
JAGRAM-PAYER, NALINI RAVIDAI,
MD
7/15/2011
ORTHOPEDIC
7/15/2018 SURGERY
N9716
JAHANGIRI, MOHAMAD FARID, MD
5/16/2011
P7289
P7290
JAHAN-TIGH, RICHARD REZA, MD
P1463
P2874
JAIJAKUL, SIRAYA , MD
JAIN, NISHANK, MD
TM00426 JAIN, SHELLY, MD
N8308
JAIN, VIPIN KUMAR, MD
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
9/6/2011 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
WI
ACTIVE
12/13/2010 None
N/A
TX
ACTIVE
11/11/2009 None
N/A
8/29/2008
11/6/2014 NEUROLOGY
GASTROENTEROLOG
8/29/2013 Y
TX
ACTIVE
9/18/2008 None
N/A
2/10/2012
TX
ACTIVE
LICENSE
ISSUED
2/16/2012 None
N/A
6/8/2012 None
N/A
ACTIVE
12/26/2012 None
N/A
ACTIVE
12/26/2012 None
N/A
ACTIVE
12/26/2012 None
N/A
6/8/2012
7/15/2013
7/15/2013
11/15/2011
4/13/2012
3/15/2011
12/15/2010
INTERNAL MEDICINE OSHKOSH
VASCULAR
NEUROLOGY
DALLAS
HOSPITALIST
HARLINGEN
INFECTIOUS
11/15/2016 DISEASES
DIAGNOSTIC
3/15/2016 RADIOLOGY
HOUSTON
TX
ACTIVE
7/22/2013 None
N/A
SPIRIT LAKE
IA
ACTIVE
8/18/2011 None
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
5/24/2011 None
N/A
7/15/2013 None
N/A
DERMATOPATHOLO
GY
TX
TX
ACTIVE
ACTIVE
11/17/2011 None
4/24/2012 None
N/A
N/A
EDEN PRAIRIE MN
OTOLOGY/NEUTOTO MOUNT
LOGY
VERNON
IL
Page 125 of 300
ACTIVE
4/12/2011 None
N/A
ACTIVE
1/6/2011 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N9075
J7797
N7437
P3358
JAMAL, NAZNIN , MD
JAMALI, MEHRNAZ NICOLE, MD
JAMEEL, ERUM, MD
JAMES, CLEVE ORIAN, MD
3/15/2011
3/1/2013
8/16/2010
6/1/2012
P1552
12/1/2011
N8408
JAMES, MICHAEL EUGENE, MD
JAMULLAMUDI, JOSEPH
SADAYANAND, MD
N7928
JANA, BAGI RP, MD
N8796
JANJUA, AASIA D, MD
N3095
P4967
JANJUA, MUHAMMAD TARIQ, MD
JANSEN, RICHARD KEITH, MD
5/29/2009
11/30/2012
N5743
P3175
JANZEN, GRANT PHILLIP, MD
JARAMILLO, ELIZABETH , MD
JARBRINK-SEHGAL, MARIA
ELLIONORE, MD
JARDELEZA, MARIA STEPHANIE
RAVADILLA, MD
4/9/2010
5/15/2012
JARIAL, RAVINDER, DO
JATAVALLABHULA, NARASIMHA
SASTRY, MD
JATSKIV, ANDREW , MD
6/4/2010
N6385
N7287
N6386
P6650
P7472
P4462
N2131
P0609
JAVERI, HETA , MD
JAVERI, ZAHIR KURBANALI, MD
JAVIER, EDUARDO PASMAN JR,
MD
P2686
P7132
1/3/2011
10/15/2010
2/15/2011
3/15/2016
3/1/2018
8/16/2015
6/1/2017
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
PHYSICAL MED. &
PULMONARY
CRITICAL CARE
5/29/2014 MEDICINE
5/15/2013
8/1/2013
9/17/2012
2/6/2009
2/6/2014 RADIOLOGY
8/2/2010
HOSPITALIST
HEMATOLOGY/ONCOL
10/15/2015 OGY
GASTROENTEROLOG
6/4/2015 Y
PLASTIC &
RECONSTRUCTIVE
6/4/2015 SURGERY
NEUROLOGICAL
5/15/2018 SURGERY
6/4/2010
Secondary Specialty
(Self-Designated)
8/1/2011
JAWAID, FARRUKH, MD
4/2/2012
JAWED, IRFAN, MD
7/1/2013
7/1/2018 ONCOLOGY
CRITICAL CARE
MEDICINE
Practice City
ALISO VIEJO
DALLAS
STAFFORD
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
CA
ACTIVE
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
Page 126 of 300
N/A
N/A
N/A
N/A
12/1/2011 None
N/A
1/21/2011 None
N/A
ACTIVE
ORLANDO
FL
ACTIVE
LICENSE
ISSUED
10/20/2010 None
N/A
2/15/2011 None
N/A
MN
CO
ACTIVE
ACTIVE
6/17/2009 None
12/13/2012 None
N/A
N/A
MA
ACTIVE
ACTIVE
LICENSE
ISSUED
4/19/2010 None
6/5/2012 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
8/24/2010 None
N/A
6/4/2010 None
N/A
SAINT PAUL
FRISCO
SAN ANTONIO TX
LICENSE
ISSUED
GENERAL SURGERY
INTERNAL MEDICINE
None
None
None
None
TX
INTERNAL MEDICINE
INFECTIOUS
DISEASES
NEURORADIOLOGY
3/15/2011
4/3/2013
8/31/2010
6/15/2012
Disciplinary
Status Date
MESQUITE
OPHTHALMOLOGY VITREOUS SURGERY BOSTON
GERIATRICS
OPHTHALMOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
LONGVIEW
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
5/17/2013 None
8/9/2013 None
N/A
N/A
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
10/8/2012 None
2/25/2009 None
N/A
N/A
8/1/2011 None
N/A
4/2/2012 None
N/A
7/1/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5653
JAWED, SAMIHA, MD
3/1/2013
N6893
7/1/2010
P2268
JAYAKAR, DAVID V, MD
JEANETTE, JOSEPH PATRICK II,
DO
N8110
JEEWA, AAMIR, MD
11/15/2010
N9572
JEHAN, EFFAT, MD
5/2/2011
P6836
JEMELKA, BROOKE ELAINE, MD
6/3/2013
P2876
JEN, HOWARD CHUNG-HAO, MD
4/13/2012
P5388
JENKINS, JOSEPH RAY, MD
N1693
JENKINS, TREVOR L, MD
3/1/2012
CARDIOVASCULAR
7/1/2015 SURGERY
HOUSTON
2/1/2013
12/12/2008
JENNINGS, ANDREW WAYNE, MD
4/1/2013
4/1/2018
N3760
P0236
JENNINGS, THOMAS JOSEPH, MD
JENSEN, BURKITT WILLIAM, MD
8/21/2009
7/1/2011
8/21/2014
7/1/2016
P7133
P0068
P5089
P5089
P5089
JENSEN, CLAIRE STEWART, MD
JENSEN, KRYSTAL KAE, MD
JEPPSON, JOSEPH JEPPA, DO
7/1/2013
6/15/2011
12/17/2012
12/17/2012
12/17/2012
7/1/2018
6/15/2016
12/17/2017
12/17/2017
12/17/2017
N0864
JERMYN, RITA ANNE, MD
P6837
JERNIGAN, SARAH, MD
P5822
JEROUDI, AHMAD MOHAMED, MD
3/15/2013
N1695
JESELSOHN, RINATH MALKA, MD
12/12/2008
N6388
JESSOP, AARON CRAIG, MD
6/3/2013
6/4/2010
HOUSTON
OBSTETRICS AND
6/3/2018 GYNECOLOGY
P6002
Practice City
VASCULAR
SURGERY
PEDIATRICS,
EMERGENCY
2/1/2018 MEDICINE
8/29/2008
Secondary Specialty
(Self-Designated)
NEUROLOGICAL
6/3/2018 SURGERY
CARDIOVASCULAR
INTERVENTIONAL
3/15/2018 DISEASES
CARDIOLOGY
TX
TX
PEDIATRIC SURGERY
SURGICAL CRITICAL
GENERAL SURGERY CARE
PEDIATRIC
OPHTHALMOLOGY
OPHTHALMOLOGY
UROLOGIC SURGERY UROLOGY
EMERGENCY
PALLIATIVE
MEDICINE
MEDICINE
ANESTHESIOLOGY
HOSPITALIST
INTERNAL MEDICINE
HOSPITALIST
INTERNAL MEDICINE
HOSPITALIST
INTERNAL MEDICINE
12/12/2013 ONCOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
NUCLEAR IMAGING
AND THERAPY
Page 127 of 300
ABILENE
TX
DALLAS
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
3/1/2013 None
N/A
7/1/2010 None
N/A
3/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
1/10/2011 None
N/A
5/2/2011 None
N/A
ACTIVE
LICENSE
ISSUED
6/6/2013 None
N/A
4/13/2012 None
N/A
2/4/2013 None
N/A
12/30/2009 None
N/A
ACTIVE
DELINQUEN
T-NON
PAYMENT
DALLAS
TX
BROWNSVILL
E
TX
HUMBLE
TX
ACTIVE
4/22/2013 None
N/A
ACTIVE
ACTIVE
8/31/2009 None
7/6/2011 None
N/A
N/A
DALLAS
HOUSTON
WAILUKU
WAILUKU
WAILUKU
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ATLANTA
TX
TX
HI
HI
HI
GA
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
9/26/2008 None
N/A
6/3/2013 None
N/A
ACTIVE
3/22/2013 None
N/A
12/29/2008 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/8/2013
6/20/2011
12/21/2012
12/21/2012
12/21/2012
License
Number
Physician Name
P6192
P1655
JETPURI, ZAIBA IQBAL, DO
JHA, MANIKA , MD
N5130
N3761
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
4/12/2013
12/15/2011
JHA, SWASTIKA, MD
JI, JIANZHONG , MD
2/5/2010
8/21/2009
INTERNAL MEDICINE
P1333
JILANI, MASOOD, MD
11/4/2011
INTERNAL MEDICINE
N6389
JILANI, SEEMA M, MD
6/4/2010
P7134
JIMENEZ, HAROLD ESTEBAN, MD
7/1/2013
P2691
N8197
JOE, TIFFANY DAISY, MD
JOGGERST, STEVEN JAMES, MD
4/2/2012
12/1/2010
N5132
JOGLEKAR, SAMIR, MD
2/5/2010
N5133
P1657
JOGLEKAR, SWATI, MD
JOHN, ABRAHAM, MD
2/5/2010
12/15/2011
P2692
P1334
JOHN, REVERLY, MD
JOHN, RUBY SAMUEL, MD
P6838
P2128
N6391
JOHN, SUNITHA SARA, MD
JOHNSON, BOBBY SUDHIR, MD
JOHNSON, CHARLES FRANKLIN,
MD
4/2/2012
11/4/2011
6/3/2013
2/10/2012
6/4/2010
FAMILY MEDICINE
EDCOUCH
AUSTIN
6/4/2015 PEDIATRICS
EMERGENCY
7/1/2018 MEDICINE
EMERGENCY
4/2/2017 MEDICINE
PULMONARY
CRITICAL CARE
4/2/2017 MEDICINE
2/5/2010 None
8/28/2009 None
N/A
N/A
11/4/2011 None
N/A
6/4/2010 None
N/A
7/1/2013 None
N/A
4/25/2012 None
12/13/2010 None
N/A
N/A
2/5/2010 None
N/A
2/5/2010 None
1/13/2012 None
N/A
N/A
4/2/2012 None
11/16/2011 None
N/A
N/A
ACTIVE
6/10/2013 None
N/A
OBSTETRICS AND
4/9/2015 GYNECOLOGY
ACTIVE
LICENSE
ISSUED
2/17/2012 None
N/A
6/4/2010 None
N/A
JOHNSON, CHERIE JEANNE, MD
4/9/2010
ACTIVE
4/26/2010 None
N/A
N5748
N8409
JOHNSON, DARYHL LINDSAY II, MD
JOHNSON, DAVID HORTON, MD
4/9/2010
1/3/2011
4/9/2015
1/3/2016
4/15/2010 None
1/10/2011 None
N/A
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
N9076
N8018
JOHNSON, DOMINIC ALASTAIR, MD
JOHNSON, EWAN DOUGLAS, MD
3/15/2011
10/29/2010
3/15/2016
10/29/2015
3/15/2011 None
11/5/2010 None
N/A
N/A
P6003
JOHNSON, JAMEEL RASHEED, MD
TX
ACTIVE
4/3/2013 None
N/A
INTERNAL MEDICINE
HOSPITALIST
INTERNAL MEDICINE
TX
PALLIATIVE
MEDICINE
HOSPITALIST
EVERGREEN
PARK
MATERNAL AND
CORPUS
FETAL MEDICINE
CHRISTI
SURGICAL CRITICAL
ABDOMINAL SURGERY CARE
INTERNAL MEDICINE ONCOLOGY
DALLAS
EMERGENCY
MEDICINE
INTERNAL MEDICINE ONCOLOGY
TOMBALL
Page 128 of 300
HOUSTON
Disciplinary
Status Date
N/A
N/A
SAN MARCOS TX
HOUSTON
TX
PLANO
Registration
Status Date
Disciplinary
Status of
Texas
License
4/12/2013 None
12/20/2011 None
N5747
4/1/2013
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
IL
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
N6394
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
6/4/2010
6/4/2015 MEDICINE
P2693
JOHNSON, JEREMY NELSON , DO
JOHNSON, KATHARINE MORTON,
MD
P3360
JOHNSON, KATIE , DO
6/1/2012
P5389
N8669
JOHNSON, KELLY ANNE, MD
JOHNSON, KELLY ANNETTE, MD
2/1/2013
2/4/2011
N7929
N6395
JOHNSON, MICHAEL EDWARD, MD
JOHNSON, RICHISA LESSICA
SAMELAJOY, MD
N7814
JOHNSON, SHALINI, MD
4/2/2012
10/15/2010
6/4/2010
10/1/2010
P5390
JOHNSON, STEVEN MICHAEL, DO
P1465
JOHNSON, VAN ALLAN JR, MD
N8198
JOHNSON, WENDY MAHONE, MD
P6839
JOLLY, AARON FRANCIS, MD
6/3/2013
N6397
JOLLY, VALERIE NICOLE, MD
6/4/2010
N3767
JONES, BENJAMIN CLIFFORD , MD
P2129
JONES, CARL RAY, DO
N7930
JONES, CHRISTINA MARIE, DO
JONES, CORTNEY VANDERBILT,
MD
JONES, DONALD VINCENT, MD
P0238
N9229
N9230
P7652
N7550
JONES, KENYATTA MIE, MD
JONES, KRISTIE ELIZABETH, MD
JONES, OLGA STRUKOVA, MD
2/1/2013
11/15/2011
12/1/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SAN ANTONIO TX
DIAGNOSTIC
2/1/2018 RADIOLOGY
2/4/2016 PEDIATRICS
ORTHOPEDIC
10/15/2015 SURGERY
EMERGENCY
6/4/2015 MEDICINE
ORTHOPEDIC
2/1/2018 SURGERY
BREAST IMAGING
FAYETTEVILLE AR
HEMATOLOGY/ONCOL
12/1/2015 OGY
CARDIOVASCULAR
6/3/2018 IMAGING
CARDIOLOGY
HOUSTON
TX
8/21/2009
EMERGENCY
8/21/2014 MEDICINE
SAN ANTONIO TX
2/10/2012
GASTROENTEROLOG
2/10/2017 Y
NACOGDOCH
ES
TX
10/15/2010
7/1/2011
4/1/2011
4/1/2011
8/15/2013
8/27/2010
HEMATOLOGY/ONCOL
7/1/2016 OGY
4/1/2016 PSYCHIATRY
SAN ANGELO
HENDERSON
CHILD AND
ADOLESCENT
PSYCHIATRY
TEMPLE
ALEDO
Page 129 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/4/2010 None
N/A
4/4/2012 None
N/A
6/1/2012 None
N/A
ACTIVE
ACTIVE
2/6/2013 None
2/11/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/5/2010 None
N/A
6/4/2010 None
N/A
10/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/21/2013 None
N/A
11/15/2011 None
N/A
12/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/18/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
9/25/2009 None
SEE
PREVIOUS
2/16/2012 ORDER
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
TX
ACTIVE
ACTIVE
TX
TX
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
10/15/2010 None
7/8/2011 None
4/6/2011 None
SEE
PREVIOUS
4/1/2011 ORDER
8/16/2013 None
9/8/2010 None
N/A
2/13/2012
N/A
N/A
N/A
9/27/2010
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N6398
JONES, PATRICK MARSH, MD
N4500
JONES, TIMOTHY ROBERT, MD
11/6/2009
N5750
JONES, WILLIAM ELTON III, MD
4/9/2010
N5134
6/4/2010
N5135
JONES, WILLIAM MOSI, MD
JORDAN, WILLIAM JEFFERSON,
MD
2/5/2010
N9717
JORGENSEN, JASON , DO
5/16/2011
P2878
JORGENSEN, TYLER SCOTT, MD
4/13/2012
2/5/2010
P1337
JOSEPH, ALLEN, MD
11/4/2011
P0239
P6431
JOSEPH, DAVID OOMMEN, MD
JOSEPH, JAMES , MD
7/1/2011
5/1/2013
N6896
JOSEPH, PRATHAP JACOB, MD
7/1/2010
TM00467 JOSHI, JAIDEEP SHRINIVAS, MD
8/15/2011
P7653
JOSHI, RAJEEV , MD
8/15/2013
P5193
JOSHI, RAVI VIVEKANAND, MD
1/4/2013
P2270
JOTWANI, VIJAY M, MD
3/1/2012
P6983
JOUMA, BASHAR N, MD
6/14/2013
P2694
N8936
JOURNIGAN, JOANN G, MD
JOYCE, REBECCA LYNNE, MD
N1698
JOYNER, MELISSA M, MD
N5137
JUAREZ, IDA , MD
4/2/2012
3/1/2011
12/12/2008
2/5/2010
Secondary Specialty
(Self-Designated)
EMERGENCY
11/6/2014 MEDICINE
RADIATION
4/9/2015 ONCOLOGY
Practice City
CORPUS
CHRISTI
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
PHYSICAL MED. &
EMERGENCY
4/13/2017 MEDICINE
INTERVENTIONAL
11/4/2016 RADIOLOGY
PHYSICAL MED. &
8/15/2016 RADIOLOGY
ELECTROPHYSIOLOG
8/15/2018 Y
CARDIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
SPORTS MEDICINE
(FAMILY PRACTICE)
CRITICAL CARE
ANESTHESIOLOGY
CARDIOVASCULAR
4/2/2017 DISEASES
RADIATION
12/12/2013 ONCOLOGY
Page 130 of 300
6/4/2010 None
N/A
ACTIVE
11/16/2009 None
N/A
SAN ANTONIO TX
ACTIVE
4/19/2010 None
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
DALLAS
DIAGNOSTIC
RADIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
Disciplinary
Status Date
TX
& REHABILITATION
PHYSICAL MED. &
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
5/19/2011 None
N/A
ROUND ROCK TX
ACTIVE
4/17/2012 None
N/A
SAN JOSE
CA
ACTIVE
11/15/2011 None
N/A
TEMPLE
EL PASO
TX
TX
ACTIVE
ACTIVE
7/6/2011 None
5/10/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/12/2010 None
N/A
8/15/2011 None
N/A
TX
ACTIVE
8/19/2013 None
N/A
CA
ACTIVE
1/8/2013 None
N/A
INDIANAPOLIS IN
ACTIVE
3/23/2012 None
N/A
MAUMEE
OH
ACTIVE
6/21/2013 None
N/A
MCKINNEY
TEMPLE
TX
TX
ACTIVE
ACTIVE
4/6/2012 None
3/11/2011 None
N/A
N/A
12/29/2008 None
N/A
2/5/2010 None
N/A
DALLAS
SAN
FRANCISCO
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
GASTROENTEROLOG
8/15/2013
8/15/2018 Y
INTERNAL MEDICINE
P7654
JULURI, RAVI, MD
P7655
JUNG, YEWAH, DO
8/15/2013
N3107
P0417
JUNTUNEN, JAMIE M, MD
JURDEN, LUCINDA ANN, MD
5/29/2009
7/15/2011
N5752
JUSTINO, EDMUNDO SAMUEL, MD
P1089
P0611
N9234
N5139
JUSTO, ANALIZA TENIDO, MD
KABIR, JAHANGIR , MD
KABLE, TIMOTHY DAVID, MD
KADAKOL, AMITHA
KRISHNAMURTHY, MD
P2271
KAFERLY, JAMES GABEL III, MD
N9077
P2014
KAGALWALLA, ABID AMIR, MD
KAHN, BEN JARONG, MD
N8411
KAHN, YOSEF, MD
4/9/2010
10/3/2011
8/1/2011
4/1/2011
2/5/2010
3/1/2012
3/15/2011
2/1/2012
1/3/2011
3/1/2017 PEDIATRICS
EMERGENCY
3/15/2016 MEDICINE
P5539
KAISER, SHAUN, MD
N8799
KALAMANGALAM, GIRIDHAR P, MD
2/15/2011
N8525
KALAMBO, MEGAN JENKINS, MD
1/18/2011
2/15/2016 NEUROLOGY
DIAGNOSTIC
1/18/2016 RADIOLOGY
10/15/2010
4/1/2011
4/1/2016 PSYCHIATRY
EMERGENCY
3/1/2017 MEDICINE
P2272
KALCICH, MICHAEL, MD
3/1/2012
HOUSTON
DALLAS
TX
TX
SAN MARCOS TX
CARDIAC
BRACHYTHERAPY/HY ELECTROPHYSIOLO
1/3/2016 PERTHERMIA
GY
KAISER, JACOB BRIAN, DO
KAISER, LARRY ROBERT, MD
2/8/2013
SAN ANTONIO TX
KINGWOOD
TX
2/5/2015 PEDIATRICS
P0241
N7815
TM00395 KALANITHI, SUMAN ARUL, MD
KALAVAPALLI, RAMPRASAD
N9235
REDDY, MD
7/1/2011
10/1/2010
EMERGENCY
5/29/2014 MEDICINE
GASTROENTEROLOG
4/9/2015 Y
INTERNAL MEDICINE
OBSTETRICS &
GYNECOLOGICAL
10/3/2016 SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
7/1/2016 PEDIATRICS
WICHITA
FALLS
HOUSTON
TX
TX
2/8/2018 NEPHROLOGY
HOUSTON
TEMPLE
Page 131 of 300
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
8/19/2013 None
N/A
8/15/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/29/2009 None
8/1/2011 None
N/A
N/A
4/9/2010 None
N/A
10/3/2011 None
8/19/2011 None
4/12/2011 None
N/A
N/A
N/A
2/5/2010 None
N/A
3/1/2012 None
N/A
ACTIVE
ACTIVE
4/1/2011 None
2/3/2012 None
N/A
N/A
LICENSE
ISSUED
1/3/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/11/2011 None
10/18/2010 None
N/A
N/A
2/8/2013 None
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
2/4/2011 None
N/A
10/15/2010 None
N/A
ACTIVE
4/6/2011 None
N/A
ACTIVE
4/2/2012 None
N/A
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
PULMONARY
CRITICAL CARE
L6970
KALEEKAL, THOMAS STEPHEN, MD
6/15/2011
6/15/2016 MEDICINE
SLEEP MEDICINE
P5825
KALIDINDI, RAVI, MD
3/15/2013
CRITICAL CARE
N5141
KALINA, AMY SUSAN, DO
2/5/2010
2/5/2015 INTERNAL MEDICINE MEDICINE (IM)
KALKONDE, YOGESHWAR
N4504
VIDYADHAR, MD
11/6/2009
11/6/2014 NEUROLOGY
P1881
KALLADA, SAHLA, MD
1/17/2012
N8800
KALRA, MONICA GHOSH, DO
2/15/2011
N6403
6/4/2010
N6404
KALU, IFEOMA A, MD
KALUVAPALLE, JAYASANKAR
REDDY, MD
6/4/2010
P4876
KALYANASWAMY, NARMADHA, MD
11/15/2012
P3012
KAMAT, SHYAMA, MD
5/1/2012
N6405
P7477
KAMATH, YOGISH DASAPPA, MD
KAMDAR, ADITI BHARAT, MD
6/4/2010
8/1/2013
N1700
KAMDAR, ANKUR ASHWIN, MD
PEDIATRIC
EMERGENCY
NEUROLOGICAL
6/4/2015 SURGERY
8/1/2018 PEDIATRICS
PEDIATRIC
P4769
KAMILI, QURAT-UL-AIN , MD
N5754
KANCHERLA, BINAL SHAH, MD
4/9/2010
PEDIATRIC
P2273
3/1/2012
N8526
KANCHERLA, DAYAKAR, MD
KANCHERLA, SHAILAJA REDDY,
MD
N5755
KANDEL, KRISTA JAHNKE, MD
12/12/2008
11/1/2012
1/18/2011
4/9/2010
N7816
KANDURU, CHAKRAVARTHY, MD
10/1/2010
N7552
KANE, ALEX A, MD
8/27/2010
Practice City
MILWAUKEE
ROSEBURG
Registration
Status of
Practice
Texas
State
License
WI
OR
TAYLORVILLE IL
NEPHROLOGY
PEDIATRICS
CEDAR PARK
HOUSTON
TX
TX
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
6/20/2011 None
4/18/2013 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
11/16/2009 None
1/23/2012 None
N/A
N/A
2/15/2011 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
11/15/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
5/9/2012 None
N/A
6/4/2010 None
9/9/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
12/22/2008 None
N/A
ALLERGY AND
IMMUNOLOGY
HOUSTON
TX
ACTIVE
12/10/2012 None
N/A
SLEEP MEDICINE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
4/16/2010 None
N/A
3/1/2012 None
N/A
ACTIVE
1/28/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/20/2010 None
N/A
10/1/2010 None
N/A
9/8/2010 None
N/A
EMERGENCY
4/9/2015 MEDICINE
DUNN
NC
SAN ANTONIO TX
PLASTIC &
RECONSTRUCTIVE
8/27/2015 SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
GASTROENTEROLOG
Y
Page 132 of 300
DALLAS
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
Practice
Start Date
End Date
Designated)
(Self-Designated)
Practice City
State
PEDIATRICS,
5/29/2009
PEDIATRICS
DALLAS
TX
GASTROENTEROLOG
5/29/2009
5/29/2014 Y
INTERNAL MEDICINE KEESLER AFB MS
5/15/2013
HOUSTON
TX
N3110
KANE, COLIN EDWARD , MD
N3111
P6653
N7817
KANG, HYON SIK, DO
KANIN, ELENITA , MD
KANJEE, SHEETAL DELIPKUMAR,
MD
N7933
KANSARA, ABHISHEK HARESH, MD
P2274
KANURI, RAVI, MD
N7707
KANZ, BRIAN NOLAN, MD
N5146
KAO, HERMAN , MD
P0072
KAPADIA, VISHAL S, MD
6/15/2011
P2133
KAPOOR, ASHWANI, MD
2/10/2012
N5758
N5759
N2138
P0242
KAPPLER, JULIE ELIZABETH, MD
KAPUR, NITIN, MD
KAPUR, VISHAL, MD
KARAK, PRASANTA KUMAR, MD
N8201
KARAM, PASCAL Y, MD
N5148
KARBAN, IRINA, DO
N8310
KARDATZKE, ELMER STANLEY, MD
N9238
KAREEM, SOHAIL, MD
P5092
KARIA, VIJAY, MD
P5092
P5092
10/1/2010
GERIATRICS
10/15/2010
3/1/2012
ORTHOPEDIC
9/15/2015 SURGERY
ORAL &
MAXILLOFACIAL
2/5/2015 SURGERY
9/15/2010
2/5/2010
4/9/2010
4/9/2010
2/6/2009
7/1/2011
12/1/2010
2/5/2010
12/15/2010
4/1/2011
FAMILY MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
RADIOLOGY
CARDIAC
ELECTROPHYSIOLOG
12/1/2015 Y
OBSTETRICS AND
2/5/2015 GYNECOLOGY
N/A
ACTIVE
ACTIVE
7/27/2009 None
5/27/2013 None
N/A
N/A
10/13/2010 None
N/A
10/15/2010 None
N/A
3/1/2012 None
N/A
9/21/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
DALLAS
TX
ACTIVE
6/21/2011 None
N/A
RICHMOND
VA
2/27/2012 None
N/A
HOUSTON
GALVESTON
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
4/9/2010
4/23/2010
2/18/2009
7/12/2011
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
12/21/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
12/30/2010 None
N/A
4/1/2011 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
FAMILY PRACTICE
RADIOLOGY
CARDIOVASCULAR
DISEASES
4/1/2016 NEPHROLOGY
INTERNAL MEDICINE
12/17/2012
INTERNAL MEDICINE
KARIA, VIJAY, MD
12/17/2012
INTERNAL MEDICINE
KARIA, VIJAY, MD
12/17/2012
INTERNAL MEDICINE
Page 133 of 300
Disciplinary
Status Date
6/4/2009 None
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
GASTROENTEROLOG
2/10/2017 Y
4/9/2015
4/9/2015
2/6/2014
7/1/2016
SAN ANTONIO TX
Registration
Status of
Texas
License
GREENCASTL
E
IN
License
Number
Physician Name
N3776
KARKAR, KAMEEL MICHEL, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/21/2009
8/21/2014 NEUROLOGY
N7819
N7441
KARNCHANASORN, SOPHANA , MD
KARNES, JONATHAN, MD
10/1/2010
8/16/2010
N6410
KARNIK, ANITA DILIP, MD
6/4/2010
N4508
11/6/2009
N7820
KARPINSKI, SYLWIA, MD
KARPOWICZ, MATTHEW
KORNELIUSZ, DO
N8527
KARR, NICHOLAS, MD
1/18/2011
10/1/2010
CHILD AND
ADOLESCENT
6/4/2015 PSYCHIATRY
THORACIC
CARDIOVASCULAR
11/6/2014 SURGERY
Registration
Status of
Secondary Specialty
Practice
Texas
(Self-Designated)
Practice City
State
License
SAN ANTONIO TX
ACTIVE
LICENSE
INTERNAL MEDICINE
ISSUED
FAMILY MEDICINE
SAN ANTONIO TX
ACTIVE
DETROIT
P4467
KARRI, SARASWATHI V, MD
9/17/2012
CARDIOTHORACIC
ANESTHESIOLOGY
P1882
1/17/2012
HOSPITALIST
P1466
KARTHIK, LAKSHMI, MD
KARTOUMAH, ALMUTAZ BILLAH,
MD
P0910
KARTVELISHVILI, ALEX, MD
9/1/2011
P2697
KARUTURI, MEGHAN SRI, MD
4/2/2012
P0741
KASHANI, NASSER , MD
N9881
KASPER, MEGAN ELIZABETH, MD
P2016
N4510
P5540
KASTURI, KRISHNA SAGAR, MD
KASULE, LOVE SOZI, MD
KATCHER, KELLY RENEE, MD
2/1/2012
11/6/2009
2/8/2013
P5282
KATHURIA, AMITA, MD
1/15/2013
N6412
KATKURI, RAJANI REDDY, MD
6/4/2010
P0612
KATRE, RASHMI SURESH, MD
8/1/2011
8/1/2016 RADIOLOGY
11/15/2011
8/15/2011
6/3/2011
MI
CLEVELAND
OH
HUNTINGDON
VALLEY
PA
INTERNAL MEDICINE
TX
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LOGY
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TX
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2/1/2017 Y
INTERNAL MEDICINE
ELMHURST
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DIABETES AND
Page 134 of 300
N/A
N/A
6/4/2010 None
N/A
11/6/2009 None
N/A
10/1/2010 None
N/A
ACTIVE
1/24/2011 None
N/A
ACTIVE
9/18/2012 None
N/A
ACTIVE
LICENSE
ISSUED
1/24/2012 None
N/A
11/15/2011 None
N/A
ACTIVE
10/12/2011 None
N/A
ACTIVE
4/26/2012 None
N/A
ACTIVE
8/18/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/15/2011 None
N/A
2/1/2012 None
12/14/2009 None
2/18/2013 None
N/A
N/A
N/A
1/28/2013 None
N/A
6/4/2010 None
N/A
8/1/2011 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
GENERAL SURGERY
10/1/2015 PATHOLOGY
EMERGENCY
1/18/2016 MEDICINE
10/1/2010 None
8/24/2010 None
LICENSE
ISSUED
PSYCHIATRY
TX
IL
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/26/2009 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
P1555
KATUNA, BRUCE ALAN, MD
P6986
KATZ, KERRY, MD
P2134
KAUFFMAN, JULIA ANNE, MD
dicaid
dicaid
Agreement
End Date
Designated)
CLINICAL
12/1/2011
12/1/2016 NEUROPHYSIOLOGY
OBSTETRICS &
GYNECOLOGICAL
6/14/2013
6/14/2018 SURGERY
2/10/2012
P6006
N4511
KAUFMAN, CAROLINE , MD
KAUR, BALJIT , MD
4/1/2013
11/6/2009
P6843
KAUR, MANREET, MD
6/3/2013
N5764
KAVANAUGH, ARTHUR SCOTT, MD
4/9/2010
N1706
KAWAI, MAKOTO , MD
N8801
KAWAMURA, DAVID HIROSHI, MD
N8020
KAY, LAURA SUE, MD
N3780
KAYAL, ANAS , MD
N5149
KAYE, JONATHAN DAVID, MD
N3782
8/21/2009
P0419
KAZA, VAIDEHI , MD
KAZAN TANNUS, JOAO FERNANDO
, MD
P0420
P7478
P4771
KAZI, BEENA , MD
KAZI, SEEMA, MD
KAZIE, NELSON, MD
7/15/2011
8/1/2013
11/1/2012
P7479
KAZIMI, FARZANEH SARAH, MD
N4513
KEAIS, JANET RENE', DO
12/12/2008
2/15/2011
10/29/2010
8/21/2009
2/5/2010
7/15/2011
8/1/2013
11/6/2009
Secondary Specialty
(Self-Designated)
Practice City
SLEEP MEDICINE
ACTIVE
12/6/2011 None
N/A
LUBBOCK
TX
ACTIVE
7/2/2013 None
N/A
ACTIVE
2/14/2012 None
N/A
ACTIVE
ACTIVE
4/11/2013 None
11/30/2009 None
N/A
N/A
6/28/2013 None
N/A
4/9/2010 None
N/A
12/17/2008 None
N/A
2/15/2011 None
N/A
10/29/2010 None
N/A
11/19/2009 None
N/A
2/5/2010 None
N/A
HOUSTON
TX
TX
8/1/2018 RADIOLOGY
PHYSICAL MED. &
Page 135 of 300
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
INTERNAL MEDICINE
PULMONARY
CRITICAL CARE
ABDOMINAL
7/15/2016 RADIOLOGY
RADIOLOGY
PEDIATRIC
EMERGENCY
PEDIATRICS
8/1/2018 PSYCHIATRY
Disciplinary
Status Date
CO
OBSTETRICS AND
4/1/2018 GYNECOLOGY
GASTROENTEROLOG GASTROENTEROLOG
6/3/2018 Y
Y
HOUSTON
NEUROPHYSIOLOGY12/12/2013 NEUROLOGY
PLASTIC &
RECONSTRUCTIVE
2/15/2016 SURGERY
EMERGENCY
10/29/2015 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
LONGMONT
DERMATOPATHOLO
GY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status of
Practice
Texas
State
License
DETROIT
MI
ACTIVE
9/1/2009 None
N/A
GALVESTON
TX
ACTIVE
8/19/2011 None
N/A
FORT PIERCE FL
ACTIVE
ACTIVE
ACTIVE
7/22/2011 None
8/5/2013 None
11/5/2012 None
N/A
N/A
N/A
PORT LAVACA TX
ACTIVE
8/12/2013 None
N/A
TYLER
ACTIVE
11/12/2009 None
N/A
TX
License
Number
P1775
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P2469
KEBEDE, TEWABE GIRMA, MD
KEELING-JOHNSON, KONYA
KAVITA, MD
1/2/2012
P7480
KEENMON, CORINNA MARIA, MD
8/1/2013
P3367
KEEPERMAN, JACOB BRIAN, MD
6/1/2012
N3784
N4514
KEHOE, SIOBHAN MARIE, MD
KEKAN, MANASI SUBHASH , MD
8/21/2009
11/6/2009
N5766
KELLY, CECILY HOSTRUP, MD
P1884
KELLY, DOUGLAS A, MD
1/17/2012
N7821
KELLY, ELISABETH , MD
10/1/2010
3/15/2012
4/9/2010
P3014
KELLY, JOHN MATTHEW, MD
5/1/2012
P2470
KELLY, KEVIN ROBERT, MD
3/15/2012
P5093
KELLY, MICHAEL JAMES, MD
12/17/2012
P5093
12/17/2012
P5093
12/17/2012
P4660
KENNEDY, CHAD MATTHEW, MD
10/15/2012
N7118
KENNEDY, JARED , MD
N6416
KENNEDY, SARAH LYNN, DO
N3786
KERENDI, FARAZ, MD
P3015
KERNAN, LEAH KATHYANN, DO
5/1/2012
P7135
KERNS, JOHNATHON SCOTT, DO
7/1/2013
7/15/2010
6/4/2010
8/21/2009
1/2/2017 NEPHROLOGY
COLON AND RECTAL
3/15/2017 SURGERY
8/1/2018 PSYCHIATRY
EMERGENCY
6/1/2017 MEDICINE
GYNECOLOGIC
8/21/2014 ONCOLOGY
Registration
Status of
Practice
Texas
State
License
Secondary Specialty
(Self-Designated)
Practice City
STOCKBRIDG
INTERNAL MEDICINE E
GA
Disciplinary
Status Date
ACTIVE
1/16/2012 None
N/A
GENERAL SURGERY MESA
GERIATRIC
PSYCHIATRY
HOUSTON
EMERGENCY
MEDICAL SERVICES SAINT LOUIS
AZ
ACTIVE
3/26/2012 None
N/A
TX
ACTIVE
8/27/2013 None
N/A
MO
ACTIVE
6/4/2012 None
N/A
GYNECOLOGY
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
10/2/2009 None
2/8/2010 None
N/A
N/A
4/9/2010 None
N/A
ACTIVE
1/20/2012 None
N/A
ACTIVE
10/13/2010 None
N/A
ACTIVE
5/7/2012 None
N/A
3/22/2012 None
N/A
12/17/2012 None
N/A
RADIATION
1/17/2017 ONCOLOGY
RADIATION
10/1/2015 ONCOLOGY
DALLAS
HOUSTON
TULSA
HEMATOLOGY/ONCOL
3/15/2017 OGY
DIAGNOSTIC
DIAGNOSTIC
DIAGNOSTIC
ORTHOPEDIC
10/15/2017 SURGERY
ORTHOPEDICS
EMERGENCY
7/15/2015 MEDICINE
THORACIC
CARDIOVASCULAR
8/21/2014 SURGERY
EMERGENCY
5/1/2017 MEDICINE
EMERGENCY
7/1/2018 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
OK
ALBUQUERQU
E
NM
SAN ANTONIO TX
EVANS
GA
ACTIVE
1/28/2013 None
N/A
EVANS
GA
ACTIVE
1/28/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/13/2012 None
N/A
7/15/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/27/2009 None
N/A
5/1/2012 None
N/A
7/1/2013 None
N/A
SAN ANTONIO TX
FAMILY PRACTICE
GENERAL SURGERY AUSTIN
Page 136 of 300
ACTIVE
LICENSE
ISSUED
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1658
KERR, CHRISTY LYNN, MD
12/15/2011
N9883
P2277
KERR, KEVIN ANDREW, MD
KERR, TREVOR , MD
6/3/2011
3/1/2012
N5153
KERSHAW, COREY DEAN, MD
2/5/2010
Secondary Specialty
(Self-Designated)
PULMONARY
2/5/2015 DISEASES
Registration
Status of
Practice
Texas
State
License
Practice City
STEPHENVILL
E
TX
STEPHENVILL
E
TX
DALLAS
TX
CRITICAL CARE
MEDICINE (IM)
GERIATRIC
MEDICINE (INTERNAL
MED)
PEDIATRIC
OAKBROOK
DERMATOLOGY
TERRACE
KERWIN, DIANA ROSE, MD
3/1/2013
F1094
KEUER, EDWARD JOHN III, MD
2/1/2013
N8802
N1362
KEY, ELAINE , MD
KEY, MARK RICHARD, MD
2/15/2011
10/10/2008
N8021
KEYHANI, ARASH , DO
10/29/2010
P6007
KEYLANI, ABDUL, MD
CARDIOVASCULAR
INTERVENTIONAL
4/1/2018 DISEASES
CARDIOLOGY
FORT WORTH TX
P5541
P0244
P0743
P0987
P2472
KHADIMALLY, KHAWER PASHA, DO
KHAIR, TARIF HISHAM, MD
KHALID, BAZGHA, MD
KHALID, HAROON, MD
KHALIL, BUSHRA , MD
2/8/2013
7/1/2011
8/15/2011
9/15/2011
3/15/2012
N0881
KHALIL, MAZEN YOUNIS, MD
8/29/2008
P5827
KHALIL, MOUNIR FAWZI, MD
3/15/2013
HOSPITALIST
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
ANESTHESIOLOGY
HEMATOLOGY/ONCOL
8/29/2013 OGY
PHYSICAL MED. &
P7656
P1339
KHALIL, QASIM, MD
KHALILI, HOUMAN , MD
8/15/2013
11/4/2011
N8803
KHAMBATY, SHABBIR , MD
2/15/2011
P2701
N5769
N8673
KHAN, AAYESHA MUMTAZ, MD
KHAN, ABDUL Q, MD
KHAN, ALI AMIN, MD
4/2/2012
4/9/2010
2/4/2011
OTORHINOLARYNGOL
4/2/2017 OGY
OTOLARYNGOLOGY
N9239
N2142
KHAN, AMEER ASIF, MD
KHAN, ASAD , MD
4/1/2011
2/6/2009
4/1/2013
2/8/2018
7/1/2016
8/15/2016
9/15/2016
3/15/2017
DALLAS
HOSPITALIST
LIVINGSTON
KANSAS CITY
ANESTHESIOLOGY
HEMATOLOGY/ONCO
LOGY
JONESBORO
IL
TX
DALLAS
SAN ANTONIO
SAN ANTONIO
HOUSTON
LAKE
CHARLES
2/6/2014 NEPHROLOGY
INTERNAL MEDICINE HEARNE
Page 137 of 300
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
TX
TX
KS
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
AR
Disciplinary
Status Date
12/19/2011 None
N/A
6/16/2011 None
3/5/2012 None
N/A
N/A
2/5/2010 None
N/A
3/1/2013 None
N/A
2/13/2013 None
N/A
2/15/2011 None
10/23/2008 None
N/A
N/A
10/29/2010 None
N/A
4/17/2013 None
N/A
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
10/7/2008 None
N/A
3/15/2013 None
N/A
8/15/2013 None
11/8/2011 None
N/A
N/A
2/15/2011 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/16/2012 None
4/22/2010 None
2/11/2011 None
N/A
N/A
N/A
LA
TX
ACTIVE
ACTIVE
4/6/2011 None
3/23/2009 None
N/A
N/A
SPINE MEDICINE
CARDIOLOGY
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
P5658
LUBBOCK
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
2/13/2013
7/20/2011
9/2/2011
12/13/2011
4/12/2012
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
CRITICAL CARE
5/15/2013
5/15/2018 MEDICINE
INTERNAL MEDICINE JOPLIN
PULMONARY
OKLAHOMA
8/1/2011
8/1/2016 MEDICINE
SLEEP MEDICINE
CITY
P6655
KHAN, ASJAD MASOOD, MD
P0615
KHAN, AZHAR ULLAH, MD
N8938
KHAN, DANISH , MD
3/1/2011
N2143
KHAN, FAISAL NAZIR AHMED, MD
2/6/2009
2/6/2014 NEPHROLOGY
P5393
P2278
P1885
N7120
KHAN, FARHAN ANWAR, MD
KHAN, HENA ZAFAR, MD
KHAN, IMRAN ANWAR, MD
KHAN, KIRAN NAWAZ, MD
2/1/2013
3/1/2012
1/17/2012
7/15/2010
2/1/2018
3/1/2017
1/17/2017
7/15/2015
P5394
N4517
2/1/2013
11/6/2009
11/6/2014 RADIOLOGY
N5771
KHAN, MEHWISH AMIR, MD
KHAN, MOHAMMAD ALI, MD
KHAN, MOHAMMAD MAHMOOD,
MD
N5155
P1092
KHAN, MOHAMMAD SAFARAZ ALI,
MD
KHAN, MUHAMMAD FUAD, MD
P3640
N7290
KHAN, OWAIS AHMED, MD
KHAN, RUBINA JAMAL, MD
4/9/2010
2/5/2010
10/3/2011
6/15/2012
8/2/2010
INTERNAL MEDICINE
FAMILY MEDICINE
INTERNAL MEDICINE
HOSPITALIST
Registration
Status of
Practice
Texas
State
License
2/5/2015 PSYCHIATRY
ACTIVE
6/3/2013 None
N/A
OK
ACTIVE
LICENSE
ISSUED
8/9/2011 None
N/A
3/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/24/2009 None
N/A
2/1/2013
3/6/2012
1/24/2012
7/27/2010
None
None
None
None
N/A
N/A
N/A
N/A
2/1/2013 None
11/16/2009 None
N/A
N/A
4/9/2010 None
N/A
2/5/2010 None
11/4/2011 None
N/A
N/A
INTERNAL MEDICINE BEEVILLE
TX
GROTON
EL PASO
CT
TX
HOUSTON
TX
INTERNAL MEDICINE
HEMATOLOGY/ONCO
LOGY
CHILD AND
ADOLESCENT
PSYCHIATRY
NEONATALPERINATAL
MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
N9241
KHAN, SHAMIMA SULTANA, MD
4/1/2011
4/1/2016 PSYCHIATRY
N2145
KHAN, SHAWN JEHAN, MD
2/6/2009
P2703
KHAN, SOBIA, MD
4/2/2012
N9243
KHAN, SUHAIL RAHMAN, MD
4/1/2011
EMERGENCY
4/1/2016 MEDICINE
N4518
KHAN, TANIA, MD
11/6/2009
P6660
N9080
KHAN, TARIQ NAWAZ, MD
KHAN, YASIR ARFAT, MD
5/15/2013
3/15/2011
TRANSPLANT
5/15/2018 SURGERY
DALLAS
TX
LICENSE
ISSUED
ACTIVE
CHICAGO
HOUSTON
IL
TX
ACTIVE
ACTIVE
6/27/2012 None
8/12/2010 None
N/A
N/A
FORT HOOD
TX
ACTIVE
4/13/2011 None
N/A
BRENHAM
TX
ACTIVE
LICENSE
ISSUED
2/20/2009 None
N/A
4/2/2012 None
N/A
IL
ACTIVE
4/21/2011 None
N/A
TX
ACTIVE
12/7/2009 None
N/A
FORT WORTH TX
GARLAND
TX
ACTIVE
ACTIVE
5/20/2013 None
4/6/2011 None
N/A
N/A
GYNECOLOGY
HOSPITALIST
ABDOMINAL
SURGERY
Page 138 of 300
Disciplinary
Status Date
MO
INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
PEORIA
WICHITA
FALLS
License
Number
P6661
P6988
Physician Name
L8761
P2136
KHAN, ZARTASH ZAFAR, MD
KHANDELWAL, SUMITRA, MD
KHANDELWAL, SUSAN KURUVILLA,
MD
KHANIJOW, VIKESH , MD
N9244
N5774
N7121
N7291
L5790
N8940
N7627
P4661
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
INFECTIOUS
5/15/2013
5/15/2018 DISEASES
INTERNAL MEDICINE WICHITA
6/14/2013
HOUSTON
5/15/2012
2/10/2012
KHATEEB, NAILA IMRAN, MD
4/1/2011
KHATIB, KHALDUN , MD
KHATRI, GAURAV, MD
KHATRI, KINNARI PATEL, MD
4/9/2010
7/15/2010
8/2/2010
4/1/2016 PEDIATRICS
GASTROENTEROLOG
4/9/2015 Y
7/15/2015 RADIOLOGY
PEDIATRIC
HEMATOLOGY/ONCOL
1/18/2016 OGY
3/1/2016 PEDIATRICS
9/1/2015 UROLOGY
KHATUA, SOUMEN, MD
KHATUA, SUTAPA, MD
KHAVARI, ROSE , MD
KHERADPOUR, RABIN, MD
1/18/2011
3/1/2011
9/1/2010
10/15/2012
P2474
P0842
KHETPAL, VIJAY, MD
KHIN, YU YU, MD
P4662
KHIRI, EMAN, MD
10/15/2012
N7292
P1189
KHOSHNEJAD, MANI , MD
KHOURY, CHAOUKI K, MD
8/2/2010
10/17/2011
N4519
N9577
P4663
P0617
KHOURY, MICHAEL GEORGE II, DO
KIBUULE, DANETTE CALICE, MD
KIDAMBI, SHANTANU SRINIVASAN,
MD
KIDANE, ALISHA KITHCART, MD
10/15/2012
8/1/2011
N8114
P5396
P7136
KIDD, LUCINA AVILA, DO
KIDD, MATTHEW CHARLES, DO
KIDWELL, DAVID THOMAS, MD
11/15/2010
2/1/2013
7/1/2013
2/1/2018 NEUROLOGY
P2880
KIEU, PHONG, MD
3/15/2012
8/26/2011
11/6/2009
5/2/2011
4/13/2012
KS
TX
PEDIATRIC
ENDOCRINOLOGY
HEPATOLOGY
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/11/2012 None
2/14/2012 None
N/A
N/A
4/1/2011 None
N/A
4/19/2010 None
7/26/2010 None
9/20/2010 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
OBSTETRICS
FAMILY
PRACTICE/OMM
& REHABILITATION
Page 139 of 300
2/3/2011
3/7/2011
11/3/2010
10/25/2012
None
None
None
None
N/A
N/A
N/A
N/A
3/26/2012 None
8/31/2011 None
N/A
N/A
NM
ACTIVE
ACTIVE
10/23/2012 None
N/A
DALLAS
PALM
SPRINGS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/2/2010 None
10/28/2011 None
N/A
N/A
CA
ACTIVE
ACTIVE
11/20/2009 None
5/18/2011 None
N/A
N/A
PUTNAM
HOUSTON
CT
TX
ACTIVE
ACTIVE
10/24/2012 None
8/5/2011 None
N/A
N/A
FORT BLISS
EL PASO
TEMPLE
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
1/11/2011 None
2/5/2013 None
7/5/2013 None
N/A
N/A
N/A
LICENSE
ISSUED
4/13/2012 None
N/A
HOBBS
URGENT CARE
MEDICINE
OBSTETRICS AND
GYNECOLOGY
NEUROLOGY
Disciplinary
Status Date
6/20/2013 None
6/20/2013 None
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
MESQUITE
DALLAS
11/6/2014 RADIOLOGY
5/2/2016 RADIOLOGY
PHYSICAL MED. &
Registration
Status of
Practice
Texas
State
License
License
Number
Physician Name
N1365
KILARU, DEEPIKA , MD
P7294
KILGORE, JULIE KARNES, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
10/10/2008
INTERNAL MEDICINE
7/15/2013
EMERGENCY
4/1/2011
4/1/2016 MEDICINE
NUCLEAR IMAGING
1/17/2012
AND THERAPY
2/1/2012
9/17/2012
PEDIATRIC
8/29/2008
INTERVENTIONAL
5/2/2011
5/2/2016 CARDIOLOGY
CARDIOLOGY
6/3/2013
6/3/2018 ONCOLOGY
ENDOCRINOLOGY,
DIABETES AND
4/12/2013
INTERNAL MEDICINE
VASCULAR
10/1/2012
10/1/2017 NEUROLOGY
NEUROLOGY
GERIATRIC MEDICINE
5/1/2012
INTERNAL MEDICINE
RADIATION
8/30/2013
8/30/2018 ONCOLOGY
PEDIATRIC
7/1/2010
INTERNAL MEDICINE
2/1/2013
CORNEA
N9247
KIM, DANIEL JIN-YOUNG, MD
P1887
P2021
P4469
KIM, DO HEE, MD
KIM, EDWARD , MD
KIM, GRACE WEN, MD
N0890
KIM, HARRY KWANG-WOO, MD
N9578
P6848
KIM, JAMES YOUNG, MD
KIM, JAMES, MD
P6197
KIM, JONGOH , MD
P4585
KIM, JONGYEOL , MD
P3019
KIM, JUNG-HOON, MD
P7791
KIM, MICHELLE MIRAN, MD
N6901
P5398
KIM, ROY JUNG WOO, MD
KIM, SOO HYUN, MD
N8804
KIM, SOO YEON, MD
N7709
KIM, STEPHEN, MD
N8022
KIM, TONI, MD
N6423
KIM, YONG SIK, MD
N7934
KIMMEL, STEPHEN GEORGE, MD
P6198
KIMYAI-ASADI, MITHRA, MD
4/12/2013
N3116
KING, FELICIA LASHAUN , MD
5/29/2009
9/15/2010
10/29/2010
6/4/2010
10/15/2010
EMERGENCY
9/15/2015 MEDICINE
PEDIATRIC
Practice City
ADDISON
ROCKWALL
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
DALLAS
TX
ACTIVE
4/8/2011 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
2/3/2012 None
2/9/2012 None
9/20/2012 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
10/9/2008 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
5/9/2011 None
6/5/2013 None
N/A
N/A
HOUSTON
TX
LICENSE
ISSUED
4/12/2013 None
N/A
LUBBOCK
TX
ACTIVE
10/3/2012 None
N/A
HOUSTON
TX
ACTIVE
5/3/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
9/9/2013 None
N/A
7/1/2010 None
2/5/2013 None
N/A
N/A
GALVESTON
GALVESTON
TX
TX
4/12/2018 RADIOLOGY
EMERGENCY
5/29/2014 MEDICINE
Page 140 of 300
2/15/2011 None
UNDER
BOARD
9/20/2010 ORDER
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/29/2010 None
N/A
6/4/2010 None
N/A
PENSACOLA FL
MORGANTOW
N
WV
ACTIVE
10/27/2010 None
N/A
ACTIVE
4/25/2013 None
N/A
HOUSTON
ACTIVE
6/3/2009 None
N/A
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
10/15/2008 None
N/A
8/13/2013 None
N/A
TX
9/9/2010
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P7485
KING, JAMES DONAVON II, MD
N8531
N7823
KING, STEPHEN PAUL, MD
KINGCAID, EVETTE , MD
P0245
P0246
KINGMA, DOUGLAS WILLIAM, MD
KINNEY, BRANDON SCOTT, MD
P4472
KINSLER, ALISON , MD
N9580
KINZLER, DAMIEN WEBB, DO
5/2/2011
P0247
KIRANE, HARSHAL DEVIDAS, MD
7/1/2011
P3179
KIRBY, JAMIE ELLEN, MD
5/15/2012
F1712
KIRKPATRICK, BRIAN, MD
4/9/2010
P6201
KIRKPATRICK, IAN SHANE, DO
N6425
KIRKWOOD, TOBY CARTER, DO
P3021
P6663
N4525
KIRUMAKI, ASHOK SATYAMURTHY,
MD
KISSEL, ABIGAIL MARION, MD
KISSLING, CARL JAMES, MD
5/1/2012
5/15/2013
11/6/2009
P3180
KISTLER, ANNALIESE ELAINE, MD
5/15/2012
N5781
4/9/2010
P4474
KITCHELL, ELLEN ELIZABETH, MD
KITTINGER, BENJAMIN JOSEPH,
MD
KIZILBASH, QURATULAIN FATIMA,
MD
N7293
KLAIR, NAVEED AHMAD, MD
P4473
8/1/2013
1/18/2011
10/1/2010
7/1/2011
7/1/2011
9/17/2012
4/12/2013
6/4/2010
9/17/2012
9/17/2012
8/2/2010
Secondary Specialty
(Self-Designated)
SPORTS MEDICINE
(FAMILY PRACTICE)
7/1/2016 PATHOLOGY
ORTHOPEDIC
9/17/2017 SURGERY
EMERGENCY
5/2/2016 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
BRYAN
TX
MILWAUKEE
WI
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
EL PASO
TX
PHILADELPHIA PA
7/1/2016 PSYCHIATRY
DALLAS
TX
TYLER
TX
4/9/2015 PSYCHIATRY
FAMILY
BALTIMORE
MD
GERIATRICS
PULMONARY
CRITICAL CARE
5/1/2017 MEDICINE
OBSTETRICS AND
INFECTIOUS
4/9/2015 DISEASES
INTERNAL MEDICINE SAINT LOUIS
DALLAS
DALLAS
INFECTIOUS
9/17/2017 DISEASES
EMERGENCY
MEDICINE
Disciplinary
Status Date
8/22/2013 None
N/A
1/18/2011 None
10/11/2010 None
N/A
N/A
7/1/2011 None
8/3/2011 None
N/A
N/A
ACTIVE
9/21/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/25/2011 None
N/A
7/1/2011 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
5/23/2012 None
N/A
4/9/2010 None
N/A
4/12/2013 None
N/A
6/4/2010 None
N/A
MO
TX
TX
ACTIVE
ACTIVE
ACTIVE
5/3/2012 None
5/23/2013 None
11/16/2009 None
N/A
N/A
N/A
AUSTIN
TX
ACTIVE
5/23/2012 None
N/A
DALLAS
TX
ACTIVE
4/20/2010 None
N/A
TEMPLE
TX
ACTIVE
9/19/2012 None
N/A
TX
ACTIVE
10/8/2012 None
N/A
TX
ACTIVE
9/15/2010 None
N/A
LAKE
JACKSON
Page 141 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
P6664
KLAR, NITASHA GREWAL, MD
P2705
KLECKNER, KENNETH, MD
N6426
P5400
N7935
KLECZEWSKI, HEATHER ANN, MD
KLEIN, JEFFREY ADAM, MD
KLEPZIG, DALE, MD
N5783
KLESNEY, DEANNA MARIE, MD
P6435
P7137
KLINGLESMITH, ROBERT E JR, MD
KLUCSARITS, SHANNON
ELIZABETH, MD
N8676
dicaid
dicaid
Agreement
End Date
Designated)
NEUROLOGY/DIAGNO
STIC
RAD/NEURORADIOLO
5/15/2013
5/15/2018 GY
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
PEDIATRIC EMER MED
6/4/2010
6/4/2015 (PEDS)
2/1/2013
10/15/2010
EMERGENCY
4/9/2010
4/9/2015 MEDICINE
DIAGNOSTIC
5/1/2013
5/1/2018 RADIOLOGY
7/1/2013
KNECHT, JOHN GEORGE III, MD
2/4/2011
N6903
N9249
KNIGHT, CAMERON DEWAYNE, MD
KNIGHT, SCOTT ALAN, MD
7/1/2010
4/1/2011
ORTHOPEDIC
7/1/2015 SURGERY
N6429
KNIGHTON, TOURE ALI, MD
6/4/2010
P3368
KNOWLES, MARTYN , MD
6/1/2012
N5784
KNUDSON, JARROD DOW, MD
4/9/2010
P4772
P5198
KOCH, CHRISTOPHER, MD
KOCH, ERIC B, MD
N5160
P5096
P5096
P5096
KOCHAR, TINA, MD
KOCUREK, EMILY GADDIS, MD
N5785
N7443
11/1/2012
1/4/2013
2/5/2010
12/17/2012
12/17/2012
12/17/2012
KODALI, PRADEEP, MD
KODAMA, ATSUKO , MD
4/9/2010
8/16/2010
TM00451 KODE SAMMARCO, LAKSHMI, MD
7/1/2011
Secondary Specialty
(Self-Designated)
AUSTIN
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
ORTHOPEDIC
4/9/2015 SURGERY
7/1/2016 RADIOLOGY
TX
PHILADELPHIA PA
ACTIVE
5/30/2013 None
N/A
4/17/2012 None
N/A
6/4/2010 None
2/6/2013 None
11/4/2010 None
N/A
N/A
N/A
TX
TX
FT HOOD
TX
ACTIVE
4/28/2010 None
N/A
HOUSTON
TX
ACTIVE
6/19/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
7/17/2013 None
N/A
2/4/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/12/2010 None
4/13/2011 None
N/A
N/A
6/4/2010 None
N/A
KY
DALLAS
TX
ACTIVE
6/7/2012 None
N/A
HOUSTON
TX
ACTIVE
4/14/2010 None
N/A
11/27/2012 None
1/9/2013 None
N/A
N/A
EDEN PRAIRIE MN
BIG SPRING
TX
FORT WORTH TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
CINCINNATI
ACTIVE
DALLAS
DALLAS
DALLAS
TX
TX
TX
Page 142 of 300
Disciplinary
Status Date
DALLAS
PITTSBURG
NEPHROLOGY
NEURO-RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ASHLAND
PEDIATRICS,
4/9/2015 PEDIATRICS
CARDIOLOGY
DIAGNOSTIC
11/1/2017 RADIOLOGY
2/5/2015
12/17/2017
12/17/2017
12/17/2017
Practice City
Registration
Status of
Practice
Texas
State
License
OH
2/5/2010
1/7/2013
1/7/2013
1/7/2013
None
None
None
None
N/A
N/A
N/A
N/A
4/9/2010 None
8/24/2010 None
N/A
N/A
7/11/2011 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N1714
KODURI, HEMANTHA KUMAR, MD
12/12/2008
P0843
KOERNER, KATHLEEN MARY, DO
8/26/2011
P0248
KOGANTI, MADHURI LATHA, MD
7/1/2011
P7138
KOH, CHESTER, MD
7/1/2013
P2883
KOHAN, JAMES MICHAEL, MD
4/13/2012
P4773
11/1/2012
N3120
KOHATSU, JORGE AUGUSTO, MD
KOHLLEPPEL, SHELLEY RENEE,
MD
N7628
KOLASA, MARK WAYNE, MD
N3121
KOLLARS, JOSHUA PATRICK , MD
N7295
KOLLI, RADHIKA, MD
P6436
N0900
N9885
KOLLI, SARITHA, DO
KOLLI, SUNIL CHOWDARY, MD
KOLLI, VIJAY KUMAR, MD
N5786
KOLSKI, GERALD BRIAN, MD
P6666
KOMMINENI, VIJAYA, MD
KONCHADA, RAVISHANKAR
SRINIVAS, MD
N8942
P3022
P1341
N5787
P6438
KONDA, SUBBAREDDY, MD
KONOPACKI, MICHAEL STUART,
MD
KONTI, JON A, MD
KONZELMANN, HENRY JOSEPH,
MD
5/29/2009
9/1/2010
5/29/2009
8/2/2010
5/1/2013
8/29/2008
6/3/2011
7/1/2016 NEUROLOGY
Secondary Specialty
(Self-Designated)
HOSPITALIST
INTERNAL MEDICINE
4/9/2010
5/15/2013
INTERNAL MEDICINE
3/1/2011
3/1/2016 RADIOLOGY
CARDIOVASCULAR
5/1/2017 SURGERY
NEURO-RADIOLOGY
11/4/2011
4/9/2010
5/1/2013
ACTIVE
3/9/2009 None
N/A
GONZALES
TX
ACTIVE
9/1/2011 None
N/A
NM
ACTIVE
7/6/2011 None
N/A
TX
ACTIVE
7/9/2013 None
N/A
CA
ACTIVE
4/18/2012 None
N/A
LA
ACTIVE
11/7/2012 None
N/A
FORT WORTH TX
ACTIVE
6/4/2009 None
N/A
RANDOLPH
AFB
TX
ACTIVE
9/7/2010 None
N/A
SAN ANTONIO TX
ACTIVE
6/12/2009 None
N/A
DESOTO
TX
8/12/2010 None
N/A
MT. VERNON
IL
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
5/1/2013 None
11/17/2008 None
6/13/2011 None
N/A
N/A
N/A
INTERNAL MEDICINE
ALLERGY AND
IMMUNOLOGY
BEMIDJI
MN
THORACIC SURGERY ROUND ROCK TX
FAMILY PRACTICE URGENT CARE 5/1/2018 EMERGENCY MED
FAMILY PRACTICE
Page 143 of 300
Disciplinary
Status Date
IL
7/1/2018 PEDIATRIC UROLOGY UROLOGIC SURGERY HOUSTON
PULMONARY
4/13/2017 MEDICINE
SLEEP MEDICINE
DEL MAR
FAMILY PRACTICE 11/1/2017 FAMILY PRACTICE
EMERGENCY MED
IOWA
CARDIAC
ELECTROPHYSIOLOG
9/1/2015 Y
CARDIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
INFECTIOUS
8/2/2015 DISEASES
INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
CHICAGO
NEURO-PHYSIOLOGY ALAMOGORD
(NEUROLOGY)
O
PEDIATRICS,
ALLERGY &
4/9/2015 IMMUNOLOGY
5/1/2012
Practice City
Registration
Status of
Practice
Texas
State
License
PILOT KNOB
MO
LICENSE
ISSUED
LICENSE
ISSUED
4/9/2010 None
N/A
5/15/2013 None
N/A
ACTIVE
3/24/2011 None
N/A
6/4/2012 None
N/A
11/4/2011 None
N/A
4/9/2010 None
N/A
5/7/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
N7631
N8677
Physician Name
P0075
KOOROS, KOOROSH, MD
KORDY, KATTAYOUN , MD
KORIMERLA, PRAVEEN
CHAKRAVARTHY, MD
N5161
P5200
P6850
P5663
P1342
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
GASTROENTEROLOG
9/1/2010
9/1/2015 Y
PEDIATRICS
2/4/2011
2/4/2016 PEDIATRICS
6/15/2011
KORIMILLI, VIJAY, MD
KORNEGAY, CHASE RYAN, MD
KORNSAWAD, KANAPA , MD
KORTEWEG, JEREMY , MD
KOSARAC, BRANKA , MD
2/5/2010
1/4/2013
6/3/2013
3/1/2013
11/4/2011
2/5/2015
1/4/2018
6/3/2018
3/1/2018
11/4/2016
P6203
KOSHY, JANICE JOHN, MD
4/12/2013
N9886
P4878
6/3/2011
11/15/2012
N1372
KOSHY, PRASHANT GEORGE, MD
KOSHY, THOMAS PHILIP, MD
KOSHY-NESBITT, SUNITA SARA,
MD
N6433
N3122
KOSS, WEGA, MD
KOSTUR, GREGORY DANIEL, MD
6/4/2010
5/29/2009
N6434
KOTHARI, AMIT JAGDISH, MD
6/4/2010
P0250
P1557
KOTTO-KOME GARCIA-SALAS,
ANNE CATHERINE ALBERTINE, MD
KOVOOR, JOHNNY GEORGE, MD
P2708
KOWALCZYK, COURTNEY ANNE,
MD
P0746
KOYA, LAXMI DEEPIKA, MD
N5790
KOZLOW, JEFFREY HALL, MD
P1467
N7554
KOZMINSKI, MATTHEW, DO
KRACHMAN, BRIAN SCOTT, DO
KRAGHA, KAYIGUVWE
ONOJUVWEVWO, MD
N0904
10/10/2008
7/1/2011
12/1/2011
4/2/2012
8/15/2011
4/9/2010
11/15/2011
8/27/2010
8/29/2008
DALLAS
DALLAS
TX
TX
CARDIOLOGY
INTERNAL MEDICINE
ANESTHESIOLOGY
INTERNAL MEDICINE
FAMILY PRACTICE
FAMILY MEDICINE
TULSA
SAN ANTONIO
WACO
GALVESTON
OK
TX
TX
TX
INFECTIOUS
DISEASES
ELECTROPHYSIOLOG
10/10/2013 Y
CARDIOLOGY
7/1/2016 PEDIATRICS
Practice City
Registration
Status of
Practice
Texas
State
License
TEMPLE
DALLAS
TX
TX
HOSPITALIST
8/29/2013 RADIOLOGY
Page 144 of 300
Disciplinary
Status Date
9/27/2010 None
2/11/2011 None
N/A
N/A
6/15/2011 None
N/A
2/5/2010
1/9/2013
7/16/2013
3/4/2013
11/10/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
4/12/2013 None
N/A
6/20/2011 None
11/19/2012 None
N/A
N/A
1/6/2009 None
N/A
6/4/2010 None
6/29/2009 None
N/A
N/A
6/4/2010 None
N/A
7/1/2011 None
12/5/2011 None
N/A
N/A
YONKERS
NY
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
4/9/2012 None
N/A
TAMPA
FL
ACTIVE
8/29/2011 None
N/A
4/9/2010 None
N/A
NEONATOLOGY
GASTROENTEROLOG
8/15/2016 Y
INTERNAL MEDICINE
PLASTIC &
RECONSTRUCTIVE
4/9/2015 SURGERY
NEUROLOGY &
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
GENERAL SURGERY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
FORT HOOD
TYLER
TX
TX
ACTIVE
ACTIVE
11/28/2011 None
9/2/2010 None
N/A
N/A
LOUISVILLE
KY
ACTIVE
1/13/2009 None
N/A
License
Number
Physician Name
P3370
KRAMADHATI, ROHITHA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
6/1/2012
PEDIATRIC CRITICAL
1/15/2013
ANATOMIC/CLINICAL
10/1/2012
10/1/2017 PATHOLOGY
CYTOPATHOLOGY
INTERVENTIONAL
8/2/2010
8/2/2015 CARDIOLOGY
CARDIOLOGY
6/1/2012
OTORHINOLARYNGOL PEDIATRIC
2/1/2012
2/1/2017 OGY
OTOLARYNGOLOGY
P5283
KRAMER, BREE CYRENE, DO
P4586
KRATZ, KURT GREGORY, MD
N7296
P3371
KRAUSE, STEVEN WILLIAM, DO
KRAVITZ, DANIEL JAY, MD
P2024
P0747
KRESS, MELISSA GALE, DO
KRESSIN, MARGARITA ROSENDO,
MD
N7297
KRIEGER, JEFFREY LOUIS, MD
P1777
N4532
P6440
KRISHNA, VIVEK RAJ, MD
KRISHNAMOORTHY, ARUN , MD
KRISHNAMURTHY, GURUPRASAD ,
MD
N6436
KRISHNAMURTHY, GURURAJ, MD
6/4/2010
N6437
P2709
KRISHNAMURTHY,
RAGHAVENDRA, MD
KRISHNAN, NIVEDITA, MD
6/4/2010
4/2/2012
6/4/2015 NEPHROLOGY
PULMONARY
CRITICAL CARE
6/4/2015 MEDICINE
4/2/2017 PEDIATRICS
N6439
KRISHNAPPA, ANURADHA, MD
6/4/2010
6/4/2015 PEDIATRICS
8/15/2011
8/2/2010
1/2/2012
11/6/2009
5/1/2013
5/2/2011
8/15/2016 UROLOGY
UROLOGIC SURGERY
GASTROENTEROLOG
8/2/2015 Y
INTERNAL MEDICINE
NEUROMUSCULAR
1/2/2017 NEUROLOGY
DISEASE
NEUROLOGY &
5/1/2018 PSYCHIATRY
PEDIATRICS
N9583
KROEKER, TERESA RUTH, MD
N8805
KRUGER, MATTHEW MICHAEL, MD
2/15/2011
N3801
KSHIRSAGAR, MALTI PATHAK, MD
8/21/2009
8/21/2014 PATHOLOGY
P5201
P0620
KUBAL, AMIT ANANT, MD
KUDAKKASSERIL, ANUP S, MD
1/4/2013
8/1/2011
P6667
KUDRATH, ABDULLA , MD
1/4/2018 RADIOLOGY
8/1/2016 PEDIATRICS
EMERGENCY
5/15/2018 MEDICINE
N5167
KUDYADI, DEEPTI SATISH, MD
5/15/2013
2/5/2010
Practice City
LITTLE ROCK
Registration
Status of
Practice
Texas
State
License
AR
ACTIVE
EL PASO
TX
ACTIVE
1/25/2013 None
N/A
DENISON
TX
ACTIVE
11/1/2012 None
N/A
QUINCY
LUFKIN
IL
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/5/2010 None
6/4/2012 None
N/A
N/A
2/1/2012 None
N/A
8/15/2011 None
N/A
TYLER
TX
ACTIVE
8/5/2010 None
N/A
GALVESTON
DALLAS
TX
TX
ACTIVE
ACTIVE
1/31/2012 None
11/13/2009 None
N/A
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
5/10/2013 None
N/A
6/4/2010 None
N/A
6/4/2010 None
4/9/2012 None
N/A
N/A
6/4/2010 None
N/A
5/2/2011 None
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
8/31/2009 None
N/A
1/4/2013 None
8/8/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
5/22/2013 None
N/A
2/5/2010 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
SLEEP MEDICINE
HEAD AND NECK
SURGERY
AUSTIN
TX
HARRISBURG PA
FORT WORTH TX
Page 145 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
6/7/2012 None
N/A
License
Number
N9085
Physician Name
KUERSTEINER, ANNAMARIA
MACALUSO, MD
dicaid
dicaid
Agreement
End Date
Designated)
3/15/2011
7/1/2013
HAND SURGERY 7/1/2018 PLASTIC SURGERY
P7139
KUHLMAN-WOOD, KATE ASHLI, MD
P6668
5/15/2013
N8532
KUHNS, CRAIG ALLEN, MD
KUKREJA, KAMLESH
UTTAMCHAND, MD
KULKARNI, ANIRUDHA PRADEEP,
DO
1/18/2011
INTERVENTIONAL
8/30/2018 RADIOLOGY
N4533
KULKARNI, ARCHANA GOVIND, MD
11/6/2009
P0076
P6205
KULKARNI, MADHULIKA
ALLAWADHI, MD
KUMAR, AMITA, MD
N5168
KUMAR, ASHU , DO
2/5/2010
2/5/2015 PEDIATRICS
N5169
2/5/2010
2/5/2015 NEPHROLOGY
N5170
P4587
KUMAR, BIRESH , MD
KUMAR, DOMALAPALLI MANEESH,
DO
KUMAR, NEIL MITHILESH, MD
2/5/2010
10/1/2012
2/5/2015 PEDIATRICS
10/1/2017 RADIOLOGY
P6011
P4588
KUMAR, RAJIV, MD
KUMAR, UMESH, MD
4/1/2013
10/1/2012
4/1/2018 RADIOLOGY
N6440
P2711
6/4/2010
4/2/2012
P7659
KUMARAN, KARTHIC R, MD
KUMAR-FLORES, JESSICA, MD
KUMMERFELD, DAVID ANDREW,
MD
8/15/2013
ORTHOPEDIC
8/15/2018 SURGERY
N4535
P6441
KUNDI, IRFAN KARIM, MD
KUNDLER, MARC WILLIS, MD
11/6/2009
5/1/2013
N8943
KUNDROTAS, LEON, MD
3/1/2011
P2712
KUNG, AMY , MD
4/2/2012
P7793
8/30/2013
6/15/2011
4/12/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
SURGERY
HOUSTON
TX
PEDIATRIC
RADIOLOGY
NEONATALPERINATAL
MEDICINE
Disciplinary
Status Date
4/4/2011 None
N/A
7/11/2013 None
N/A
5/15/2013 None
N/A
8/30/2013 None
N/A
1/18/2011 None
N/A
1/6/2010 None
N/A
AMARILLO
TX
ACTIVE
HOUSTON
LEXINGTON
TX
KY
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/20/2011 None
4/22/2013 None
N/A
N/A
2/5/2010 None
N/A
2/5/2010 None
N/A
2/5/2010 None
11/5/2012 None
N/A
N/A
4/4/2013 None
10/5/2012 None
N/A
N/A
6/4/2010 None
4/16/2012 None
N/A
N/A
8/15/2013 None
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
11/6/2009 None
5/3/2013 None
N/A
N/A
TX
ACTIVE
3/14/2011 None
N/A
4/2/2012 None
N/A
PEDIATRIC EMER
MED (PEDS)
DALLAS
TX
GENERAL PRACTICE SAN ANTONIO TX
HOSPITALIST
SARTELL
INTERNAL MEDICINE
5/1/2018 PSYCHIATRY
TAYLOR
GASTROENTEROLOG
LACKLAND,
3/1/2016 Y
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
4/2/2017 GYNECOLOGY
SURGERY
Page 146 of 300
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
MN
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1095
KUNIYIL, JESHEEJA, MD
10/3/2011
N7126
KUNJUMMEN, BINU JAMES, MD
7/15/2010
N9726
KUO, JAMES ANDREW, MD
5/16/2011
PEDIATRICS,
P6989
KUO, JEFF, MD
6/14/2013
P1558
N8204
KUREPA, DALIBOR, MD
KURIAN, ASHA MARY, MD
12/1/2011
12/1/2010
P3374
KURKJIAN, THEODORUS
JONATHAN, MD
6/1/2012
N7299
KURUPATH, VINOD, MD
8/2/2010
N6443
P4667
P2886
P4879
KURZ, MICHAEL WAYNE, MD
KUSEMIJU, OLADIPO AJOSE, MD
KUTAGULA, VINAY
VENGAREDDIGARI, MD
KUYE, TAIWO ADEYINKA, MD
P0424
KWAN, CHRISTINE, MD
N9584
KWAN, NATHAN ANDREW, MD
N8806
KWON, ROBERT KANG, MD
2/15/2011
P3375
LABAULT-SANTIAGO, JOSE
RAFAEL, MD
6/1/2012
N2613
LABORDE, CARRIE ELIZABETH, MD
4/3/2009
P7660
LABORDE, CATHERINE, MD
N5174
LABUDA, SARAH , MD
6/4/2010
10/15/2012
4/13/2012
11/15/2012
7/15/2011
5/2/2011
8/15/2013
2/5/2010
Secondary Specialty
(Self-Designated)
Practice City
STATEN
ISLAND
Registration
Status of
Practice
Texas
State
License
NY
N/A
7/15/2010 None
N/A
ACTIVE
5/24/2011 None
N/A
TX
ACTIVE
6/18/2013 None
N/A
SHREVEPORT LA
EL PASO
TX
ACTIVE
ACTIVE
12/12/2011 None
12/23/2010 None
N/A
N/A
ACTIVE
6/25/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
8/20/2010 None
N/A
6/4/2010 None
12/21/2012 None
N/A
N/A
4/24/2012 None
11/21/2012 None
N/A
N/A
7/15/2011 None
N/A
5/5/2011 None
N/A
2/15/2011 None
N/A
FORT WORTH TX
PEDIATRIC
FORENSIC MEDICINE PAMPA
PEDIATRICS
PLASTIC &
RECONSTRUCTIVE
6/1/2017 SURGERY
GASTROENTEROLOG
8/2/2015 Y
INTERNAL MEDICINE
EMERGENCY MED
GERIATRICS PALLIATIVE
OBSTETRICS AND
5/2/2016 GYNECOLOGY
PLASTIC &
RECONSTRUCTIVE
2/15/2016 SURGERY
6/1/2017 NEUROLOGY
PEDIATRIC
HEMATOLOGY/ONCOL
4/3/2014 OGY
EMERGENCY
8/15/2018 MEDICINE
Disciplinary
Status Date
10/26/2011 None
INTERVENTIONAL
CARDIOLOGY
HOUSTON
TX
PICAYUNE
MS
ADDISON
HARLINGEN
TX
TX
KILLEEN
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
HAND SURGERY
LICENSE
ISSUED
NEURO-PHYSIOLOGY
(NEUROLOGY)
SAN ANTONIO TX
ACTIVE
6/6/2012 None
N/A
ACTIVE
4/8/2009 None
N/A
8/19/2013 None
N/A
2/5/2010 None
N/A
PEDIATRICS
URGENT CARE
MEDICINE
2/5/2015 PEDIATRICS
Page 147 of 300
DALLAS
TX
ACTIVE
LICENSE
ISSUED
License
Number
P6669
Physician Name
LACHMANSINGH, JINESH
STEPHAN, MD
N9381
P0251
LACY, TIMOTHY LESTER, MD
LADHA, MALIK MOLEDINA, MD
P6853
LAETSCH, THEODORE WILLIS JR,
MD
N7445
LAGISETTY, JYOTHI RAMA, MD
P3185
LAI, ERIC CHRISTIAN, MD
P4881
LAI, VICTOR TINFUNG, MD
P1559
LAIRD, AMANDA MICHELLE, MD
P6854
P1661
N7825
LAIRD, JOSHUA CODY, MD
LAKHANI, ASIF WAHID, MD
LAKHIA, RONAK , MD
P7794
LAKKO, ROBERT JORDAN, DO
N6906
LAKSHMAN, THIRU VENKAT, MD
LAKSHMINARASIMHIAH, PRASAD,
MD
N9463
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CRITICAL CARE
5/15/2013
ANESTHESIOLOGY
PAIN MANAGEMENT
7/1/2011
PEDIATRIC
HEMATOLOGY/ONCOL
6/3/2013
6/3/2018 OGY
EMERGENCY
PEDIATRIC EMER
8/16/2010
8/16/2015 MEDICINE
MED (EM)
PLASTIC &
RECONSTRUCTIVE
5/15/2012
5/15/2017 SURGERY
11/15/2012
12/1/2011
6/3/2013
12/15/2011
10/1/2010
8/30/2013
7/1/2010
4/15/2011
EMERGENCY
6/3/2018 MEDICINE
FAMILY
COLON AND RECTAL
7/1/2015 SURGERY
PHYSICAL MED. &
PHYSICAL MED. &
4/8/2011
N7633
LALANI, FARHAN FAROOQ, MD
9/1/2010
N9585
N3807
LALLISS, STEVEN JOHN, MD
LALWANI, SONESH KUMAR, MD
5/2/2011
8/21/2009
ORTHOPEDIC
5/2/2016 SURGERY
P0078
LAMA-BRISENO, TRACY R, DO
6/15/2011
LAMBERT, EDDIE L, MD
6/14/2013
Disciplinary
Status Date
5/15/2013 None
N/A
MA
TX
ACTIVE
ACTIVE
4/15/2011 None
7/6/2011 None
N/A
N/A
DALLAS
TX
ACTIVE
6/4/2013 None
N/A
HOUSTON
TX
ACTIVE
8/19/2010 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
5/15/2012 None
N/A
11/15/2012 None
N/A
TX
ACTIVE
12/20/2011 None
N/A
HOUSTON
INTERNAL MEDICINE BRYAN
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
6/6/2013 None
2/9/2012 None
10/20/2010 None
N/A
N/A
N/A
OBSTETRICS
TX
ACTIVE
9/4/2013 None
N/A
TX
ACTIVE
7/15/2010 None
N/A
SAN ANTONIO TX
ACTIVE
4/21/2011 None
SEE
PREVIOUS
4/8/2011 ORDER
N/A
SURGICAL
ONCOLOGY
TEMPLE
HEREFORD
GENERAL SURGERY AUSTIN
PAIN
MANAGEMENT/REHA
B MED
LAL, SUNDEEP S, MD
Registration
Status Date
Disciplinary
Status of
Texas
License
HOLYOKE
BRYAN
N9382
P6990
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
MCALLEN
COLON AND RECTAL
SURGERY
HOUSTON
Page 148 of 300
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
4/11/2011
9/1/2010 None
N/A
5/2/2011 None
9/8/2009 None
N/A
N/A
6/15/2011 None
N/A
7/12/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
LAMBERT, JERRY V JR, MD
9/15/2011
N4537
LAMBERT, THOMAS JOSEPH II, MD
11/6/2009
N3129
5/29/2009
N5797
N2157
LAMIA, TATIANA , MD
LANDAVERDE, CARMEN ELENA,
MD
LANDEN, DONNA AKANE, MD
PHYSICAL MED. &
4/9/2010
2/6/2009
4/9/2015 HEPATOLOGY
N5177
LANDFIELD, ALEXANDER, MD
2/5/2010
P6206
LANDHERR, KATHRYN M, MD
4/12/2013
2/5/2015 NEUROLOGY
OBSTETRICS AND
P1344
LANDRUM, MICHAEL L, MD
8/2/2010
11/4/2011
G6200
LANDSMAN, IRA SETH, MD
2/5/2010
N6445
6/4/2010
N3812
LANG, CATHLEEN ANN, MD
LANGAN, CHRISTOPHER JOHN,
MD
N2874
LANGELAND, DAWN TU-DONG, MD
4/3/2009
P0844
8/26/2011
N6447
P3186
LANSKI, STEVEN L, MD
LAPEROUSE, LAMBERT MARK JR,
MD
LARA, ANNA KOPIECZEK, MD
N3815
P2715
LARGENT, MATTHEW
CHRISTOPHER, MD
LARIOS, PATRICIA , MD
8/21/2009
4/2/2012
P2138
LAROCHE, LAUREN ASHLEIGH, MD
2/10/2012
N9888
LAROSA, STEVEN PHILIP, MD
8/21/2009
6/4/2010
5/15/2012
6/3/2011
Practice City
EMERGENCY
9/15/2016 MEDICINE
P0991
TM00380 LANDRIEU, LAURA LEGENDRE, MD
Secondary Specialty
(Self-Designated)
8/2/2015 RADIOLOGY
INFECTIOUS
11/4/2016 DISEASES
TYLER
HOUSTON
GASTROENTEROLOG
Y
DALLAS
BREAST IMAGING
Registration
Status of
Practice
Texas
State
License
DELINQUEN
T-NON
PAYMENT
6/4/2015 PEDIATRICS
EMERGENCY
8/21/2014 MEDICINE
PEDIATRIC
EMERGENCY
EMERGENCY
6/4/2015 MEDICINE
ORAL &
MAXILLOFACIAL
8/21/2014 SURGERY
EMERGENCY
2/10/2017 MEDICINE
INFECTIOUS
6/3/2016 DISEASES
INTERNAL MEDICINE
Page 149 of 300
12/14/2011 None
N/A
ACTIVE
11/16/2009 None
N/A
TX
ACTIVE
6/5/2009 None
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
4/14/2010 None
3/2/2009 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
4/23/2013 None
N/A
ACTIVE
9/6/2010 None
N/A
11/10/2011 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
GULF BREEZE FL
KANSAS CITY MO
HOUSTON
Disciplinary
Status Date
TX
PEDIATRIC ANES
(PEDS)
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
8/27/2009 None
N/A
SAN ANTONIO TX
ACTIVE
4/14/2009 None
N/A
EL PASO
TX
9/6/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
6/4/2010 None
6/15/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
10/5/2009 None
4/4/2012 None
N/A
N/A
2/10/2012 None
N/A
ACTIVE
6/10/2011 None
N/A
SAN ANTONIO TX
DALLAS
TX
TEMPLE
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
8/27/2010
N9086
P0751
LARRAZOLO, OSCAR GABRIEL, MD
LARRISON, DEBORAH MARLAINE,
MD
LARSEN, DOUGLAS ALAN, MD
3/15/2011
8/15/2011
8/15/2016 PATHOLOGY
N5799
P0752
LARSEN, REAGAN , MD
LARSON, ADAM, MD
4/9/2010
8/15/2011
4/9/2015 PEDIATRICS
N0912
LARSON, ANNE MARIE, MD
8/29/2008
8/29/2013 HEPATOLOGY
N5182
LARSON, CLAIRE RUTH, MD
2/5/2010
N8207
LARSON, KELLY SUZANNE, MD
12/1/2010
P6670
LARSON, TIMOTHY BRAD, MD
LASAKI, ABIOSE OLUFUNMILAYO,
MD
N7556
P4668
N6449
N2619
N4538
N4539
LASEGE, TAMIKA BRANDON, MD
LASEK-NESSELQUIST, SUZANNE,
MD
LASITER, JOHN CLINTON, MD
LATHROP, KATE IDA, MD
LATTA, TAMIKA DANIELLE
SHAUNTA, MD
LAUREL, PATRICIA , MD
Secondary Specialty
(Self-Designated)
CYTOPATHOLOGY
HOUSTON
TX
ACTIVE
SOUTHLAKE
TEMPLE
TX
TX
SLC
UT
GASTROENTEROLOG
Y
DALLAS
CORPUS
CHRISTI
5/15/2013
ORTHOPEDICS
10/15/2012
PUBLIC HEALTH
CINCINNATI
SALT LAKE
CITY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/7/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
3/29/2011 None
8/18/2011 None
N/A
N/A
4/9/2010 None
8/29/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
9/22/2008 None
N/A
2/5/2010 None
N/A
TX
ACTIVE
1/18/2011 None
N/A
OH
ACTIVE
5/23/2013 None
N/A
UT
ACTIVE
10/24/2012 None
N/A
6/4/2010 None
N/A
4/8/2009 None
12/22/2009 None
11/25/2009 None
N/A
N/A
N/A
5/15/2012 None
10/27/2008 None
N/A
N/A
6/15/2011 None
N/A
TX
GENERAL PRACTICE
5/15/2018 SURGERY
6/4/2010
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
4/3/2009
11/6/2009
11/6/2009
5/15/2012
10/10/2008
LAURICH, REBECCA LYNN, MD
LAVEDAN, ANNA LIZA CAMUNGOL,
MD
6/15/2011
4/1/2013
OMAHA
NE
ACTIVE
4/5/2013 None
N/A
3/1/2013
SHREVEPORT LA
ACTIVE
3/8/2013 None
N/A
P2025
LAVIOLETTE, JUDY DERRICK, MD
LAWRENCE, ANGELENE
MICHAELE, MD
RENO
NV
ACTIVE
2/10/2012 None
N/A
P0753
LAWRENCE, EMILY JEAN, DO
HOUSTON
TX
ACTIVE
8/30/2011 None
N/A
P3188
N1378
P0079
P6014
P5667
2/1/2012
8/15/2011
2/1/2017 PSYCHIATRY
PEDIATRICS,
TX
COLUMBIA
MO
SAN ANTONIO TX
FAMILY PRACTICE
SAN ANTONIO TX
PSYCHIATRY
CARDIOVASCULAR
DISEASES
Page 150 of 300
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
LAWSON, NICHOLETTE MICHELLE,
EMERGENCY
N9088
MD
3/15/2011
3/15/2016 MEDICINE
N7302
LAXMISAN, ARCHANA, MD
8/2/2010
LAYEEQUR RAHMAN,
SURGICAL BREAST
P2283
RAKHSHANDA , MD
3/1/2012
3/1/2017 ONCOLOGY
GENERAL SURGERY
N4543
LAZAR, DAVID ALEXANDER, MD
11/6/2009
VASCULAR
P4973
LAZARIDIS, CHRISTOS , MD
11/30/2012
NEUROLOGY
LAZARINI, JONATHAN ALEXANDER,
P6209
MD
4/12/2013
K5140
LAZARO, LARRY RIVERA, MD
7/1/2011
HOSPITALIST
N6450
LAZOL, JUDITH PANERGO, MD
6/4/2010
6/4/2015 PEDIATRICS
CARDIOLOGY
N7128
LAZZOPINA, PETER , MD
7/15/2010
N8210
N8208
LE VOYER, THOMAS EUGENE, MD
LE, CHUONG, MD
12/1/2010
12/1/2010
SURGICAL
12/1/2015 ONCOLOGY
12/1/2015 NEUROLOGY
N7129
N9586
LE, DAN, MD
LE, HOANG LINH, MD
7/15/2010
5/2/2011
P7300
LE, LIET NGOC, MD
7/15/2013
N8026
P2284
LE, LONG NGUYEN XUAN, MD
LE, MICHAEL, MD
P2887
LE, MINH MAN, MD
4/13/2012
N8535
P1096
N4544
LE, NAM HOAI, MD
LE, PHUC NHAT, MD
LE, RICHARD TAN, DO
1/18/2011
10/3/2011
11/6/2009
P3376
P1779
LE, Y THANH, DO
LEAK, MORGAN GRANT, MD
6/1/2012
1/2/2012
H8993
LEAL, DANIEL HECTOR, MD
6/15/2012
10/29/2010
3/1/2012
AMARILLO
TX
Practice City
ACTIVE
ACTIVE
3/5/2012 None
11/30/2009 None
N/A
N/A
CHARLESTON SC
ACTIVE
1/8/2013 None
N/A
FORT WORTH TX
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/29/2013 None
N/A
7/1/2011 None
N/A
6/4/2010 None
N/A
7/15/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
12/10/2010 None
1/31/2011 None
N/A
N/A
7/15/2010 None
5/27/2011 None
N/A
N/A
ACTIVE
8/8/2013 None
N/A
TX
ACTIVE
ACTIVE
11/3/2010 None
3/30/2012 None
N/A
N/A
FL
ACTIVE
4/16/2012 None
N/A
1/26/2011 None
10/6/2011 None
11/24/2009 None
N/A
N/A
N/A
6/1/2012 None
1/23/2012 None
N/A
N/A
6/18/2012 None
N/A
REMUS
FAMILY MEDICINE
WINTER
HAVEN
6/1/2017 PEDIATRICS
ADDICTION
PSYCHIATRY
Page 151 of 300
Disciplinary
Status Date
N/A
N/A
MI
DERMATOLOGIC
SURGERY
HAND SURGERY
FAMILY PRACTICE
Registration
Status Date
Disciplinary
Status of
Texas
License
3/15/2011 None
9/6/2010 None
NASHVILLE
TN
PULMONARY
CRITICAL CARE
10/29/2015 MEDICINE
EMERGENCY
4/13/2017 MEDICINE
PLASTIC &
RECONSTRUCTIVE
1/18/2016 SURGERY
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
BEAUMONT
TX
FORT WORTH TX
AMARILLO
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
License
Number
Physician Name
P7795
LEATHAM, AUNA OTTS, MD
N8027
LEBA, THU BA, MD
K6640
LEDLEY, ANNMARIE MCRENA, DO
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
8/30/2013
8/30/2018 MEDICINE
ORTHOPEDIC
10/29/2010
10/29/2015 SURGERY
P3026
LEE, ANHTUYET THI BUI, MD
5/1/2012
OBSTETRICS AND
2/6/2014 GYNECOLOGY
PLASTIC &
RECONSTRUCTIVE
5/1/2017 SURGERY
P5668
LEE, BENJAMIN SWEE LENG, MD
3/1/2013
3/1/2018 NEPHROLOGY
2/6/2009
P2477
P1560
LEE, BOWLVA MICHAEL, DO
LEE, DANIEL WONIL, MD
3/15/2012
12/1/2011
P5832
LEE, FAYE, MD
3/15/2013
P0846
LEE, FRANCESCA M, MD
8/26/2011
N4547
LEE, FRANK MICHAEL, MD
11/6/2009
N6453
P2888
LEE, GRACE LAUREN, MD
LEE, HUN JU, MD
6/4/2010
4/13/2012
N6454
LEE, JAMES TE-AN, MD
6/4/2010
P5202
P7662
LEE, JANA, MD
LEE, JANE EVELYN, DO
1/4/2013
8/15/2013
P7301
LEE, KATIE AMY, MD
7/15/2013
P0622
LEE, KEAGAN HYUN-CHUL, MD
P4976
LEE, KENNETH THOMAS, MD
P2717
LEE, KIWON, MD
N2167
P0081
LEE, MARK ROBERT, MD
LEE, PAUL STEVEN, MD
8/1/2011
11/30/2012
4/2/2012
2/6/2009
6/15/2011
12/1/2016 RADIOLOGY
EMERGENCY
3/15/2018 MEDICINE
INFECTIOUS
8/26/2016 DISEASES
EMERGENCY
11/6/2014 MEDICINE
4/13/2017 ONCOLOGY
DIAGNOSTIC
6/4/2015 RADIOLOGY
EMERGENCY
1/4/2018 MEDICINE
ANATOMIC/CLINICAL
8/1/2016 PATHOLOGY
THORACIC
CARDIOVASCULAR
11/30/2017 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
GREENVILLE
NEW
ORLEANS
CORPUS
CHRISTI
NEURO-RADIOLOGY
PATHOLOGY
URGENT CARE
MEDICINE
NEW YORK
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
10/29/2010 None
SEE
PREVIOUS
3/10/2009 ORDER
N/A
N/A
ACTIVE
LA
ACTIVE
5/7/2012 None
N/A
TX
ACTIVE
3/20/2013 None
N/A
NY
ACTIVE
ACTIVE
3/23/2012 None
12/30/2011 None
N/A
N/A
ACTIVE
4/24/2013 None
N/A
9/2/2011 None
N/A
11/18/2009 None
N/A
6/4/2010 None
4/26/2012 None
N/A
N/A
6/4/2010 None
N/A
TX
ACTIVE
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
2/3/2006
GLENDALE
AZ
ACTIVE
ACTIVE
1/9/2013 None
8/19/2013 None
N/A
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
7/23/2013 None
N/A
8/1/2011 None
N/A
TX
ACTIVE
12/4/2012 None
N/A
TX
ACTIVE
4/16/2012 None
N/A
TX
ACTIVE
ACTIVE
3/25/2009 None
6/21/2011 None
N/A
N/A
DERMATOPATHOLO
GY
GENERAL SURGERY TEXARKANA
HOUSTON
4/2/2017 NEUROLOGY
NEUROLOGICAL
2/6/2014 SURGERY
Page 152 of 300
8/30/2013 None
Disciplinary
Status Date
TX
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
AUSTIN
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N6456
N8417
LEE, RICHARD WALKER, MD
LEE, ROBERT NIEN HUA, DO
6/4/2010
1/3/2011
P7143
LEE, SABINA MIKYONG, MD
7/1/2013
P0847
LEE, SANG HYUN, MD
8/26/2011
P3190
LEE, SEUNG TAE , MD
5/15/2012
N9089
LEE, SHARON, MD
3/15/2011
N9728
LEE, TANIA MONGE, MD
5/16/2011
N3823
LEFFLER, BRIAN JAMES, MD
8/21/2009
N3824
P4477
LEFORT, ROXANNA, MD
LEGARDA, EUGENIA , MD
8/21/2009
9/17/2012
P7144
P6015
LEGER, KASEY JOANNE, MD
LEHMAN, WESTON MARK, MD
P6993
LEHMANN, ANA ROSA, MD
7/1/2013
4/1/2013
6/14/2013
Practice City
GENERAL VASCULAR
6/4/2015 SURGERY
1/3/2016 PEDIATRICS
EMERGENCY
8/26/2016 MEDICINE
HEMATOLOGY/ONCOL
5/15/2017 OGY
PEDIATRIC
ANESTHESIOLOGY
3/15/2016 (PEDS)
OBSTETRICS AND
PEDIATRIC EMER MED
8/21/2014 (PEDS)
7/1/2018 PEDIATRICS
3/15/2012
3/15/2017 PATHOLOGY
P1097
LEMO, PRETEI EBIKEME, MD
10/3/2011
J1293
LENDER, DAN, MD
P2480
LENERT-WILLIAMS, CARMELL, MD
3/15/2012
ENDOCRINOLOGY,
DIABETES AND
7/1/2016 METABOLISM
EMERGENCY
3/15/2017 MEDICINE
N6457
N4549
LENTE, ADELA, MD
LEONARD, RONALD L., DO
6/4/2010
11/6/2009
11/6/2014 PATHOLOGY
P3028
LEVAR, JOSHUA , MD
5/1/2012
Disciplinary
Status Date
HOUSTON
TX
HOUSTON
TX
ACTIVE
9/2/2011 None
N/A
TX
ACTIVE
5/30/2012 None
N/A
SAN ANTONIO TX
ACTIVE
4/18/2011 None
N/A
ACTIVE
5/24/2011 None
N/A
INFECTIOUS
DISEASES
EMERGENCY
MEDICAL SERVICES
OBSTETRICS &
GYNECOLOGICAL
SURGERY
SPORTS MEDICINE
(FAMILY PRACTICE)
PATHOLOGY
N/A
N/A
7/1/2013 None
N/A
TX
ACTIVE
8/28/2009 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
8/28/2009 None
9/19/2012 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
7/24/2013 None
4/15/2013 None
N/A
N/A
6/14/2013 None
N/A
COLLEGEVILL
E
PA
ACTIVE
3/22/2012 None
N/A
GREENVILLE
TX
ACTIVE
10/13/2011 None
N/A
TX
ACTIVE
7/7/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
4/2/2012 None
N/A
6/4/2010 None
11/12/2009 None
N/A
N/A
5/1/2012 None
N/A
SHREVEPORT LA
Page 153 of 300
6/4/2010 None
1/13/2011 None
PLAINVIEW
LEI, JUNYI , MD
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
DALLAS
TEMPLE
P2479
7/1/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
PARSONS
KS
License
Number
N4551
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
LEVENT, FATMA , MD
11/6/2009
11/6/2014
TM00452 LEVEY, MICHAEL STEVEN, MD
N7449
LEVINE, HAROLD R II, MD
7/1/2011
8/16/2010
7/1/2016
8/16/2015
N5807
N3828
LEWIS, DAWN RENEE, MD
LEWIS, NEIL PENDRIL , MD
4/9/2010
8/21/2009
4/9/2015
8/21/2014
P4671
LEWIS, RYAN LEIGHTON, MD
10/15/2012
10/15/2017
P6858
N9464
P0428
LI, HUAIGUANG, MD
LI, LI , MD
LI, LINDA , MD
N2173
LI, MORGAN KUANG-TSU, MD
P7799
P7800
P7302
P2890
N0924
6/3/2013
4/15/2011
7/15/2011
PEDIATRIC
INFECTIOUS DISEASE
DIAGNOSTIC
RADIOLOGY
RADIOLOGY
OBSTETRICS AND
GYNECOLOGY
INTERNAL MEDICINE
EMERGENCY
MEDICINE
2/6/2009
EMERGENCY
2/6/2014 MEDICINE
LIANG, MIKE KUO, MD
LIANG, MIN , MD
8/30/2013
8/30/2013
LIANG, QINGHUA, MD
LIAO, GEORGE PAUL, MD
LIBED, CHERRYLL PHOEBE
TARUC, MD
7/15/2013
4/13/2012
7/15/2018 NEUROLOGY
8/29/2008
ORTHOPEDIC
4/2/2017 SURGERY
INTERNAL MED - PREV
7/15/2016 MED
P2719
LIBERMAN, SHARI RACHEL, MD
4/2/2012
P0429
LIBREROS, JAIRO ANDRES, MD
7/15/2011
N9892
LIE, OCTAVIAN VIOREL, MD
6/3/2011
6/3/2016 NEUROLOGY
N5808
LIEBERMAN, ISADOR HARRY, MD
4/9/2010
ORTHOPEDIC
4/9/2015 SURGERY
N1735
LIEN, ELLISIV, MD
12/12/2008
PHYSICAL MED. &
Secondary Specialty
(Self-Designated)
PEDIATRICS
Practice City
LUBBOCK
12/7/2009 None
N/A
OH
TX
ACTIVE
ACTIVE
7/6/2011 None
8/20/2010 None
N/A
N/A
LEWISTON
AUSTIN
ME
TX
ACTIVE
ACTIVE
4/28/2010 None
9/3/2009 None
N/A
N/A
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
10/19/2012 None
N/A
6/3/2013 None
4/29/2011 None
7/22/2011 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
2/25/2009 None
N/A
8/30/2013 None
9/6/2013 None
N/A
N/A
7/15/2013 None
4/16/2012 None
N/A
N/A
FORT WORTH TX
ACTIVE
9/15/2008 None
N/A
HOUSTON
ACTIVE
4/9/2012 None
N/A
ACTIVE
7/20/2011 None
N/A
ACTIVE
6/13/2011 None
N/A
4/9/2010 None
N/A
12/17/2008 None
N/A
HOUSTON
TX
AUSTIN
TX
MOVEMENT
DISORDERS
HOUSTON
TX
TX
CLINICAL
NEUROPHYSIOLOGY SAN ANTONIO TX
ORTHOPEDIC
SURGERY OF THE
SPINE
PLANO
TX
& REHABILITATION
TYLER
Page 154 of 300
Disciplinary
Status Date
ACTIVE
HOSPITALIST
SURGERY
ADMINISTRATIVE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
COLUMBUS
CARDIOLOGY
EMERGENCY
MEDICAL SERVICES
Registration
Status of
Practice
Texas
State
License
TX
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRIC CRITICAL
5/1/2012
GERIATRIC MEDICINE
11/15/2011
SURGICAL
3/15/2013
3/15/2018 ONCOLOGY
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
CARDIOVASCULAR
8/1/2011
8/1/2016 DISEASES
THORACIC
CARDIOVASCULAR
6/8/2012
6/8/2017 SURGERY
OBSTETRICS AND
5/1/2013
5/1/2018 GYNECOLOGY
INTERVENTIONAL
5/15/2012
ORTHOPEDIC
5/16/2011
5/16/2016 SURGERY
PEDIATRIC
HEMATOLOGY/ONCOL
4/1/2013
4/1/2018 OGY
HEMATOLOGY/ONCOL
6/4/2010
6/4/2015 OGY
8/16/2010
8/16/2015 ONCOLOGY
PULMONARY
CRITICAL CARE
4/13/2012
4/13/2017 MEDICINE
PEDIATRIC
12/12/2008
11/6/2009
1/2/2012
1/2/2017 RADIOLOGY
P3030
LIEPPMAN, KYLE, MD
P1469
LIETO, JANET, DO
P5836
LILES, JOE SPENCER, MD
P7148
LIM, DAVID TAO-WAY, DO
P0624
LIM, HAJIN, MD
P3549
LIMA, BRIAN, MD
P6448
LIMAS, FLOR AURORA, MD
P3191
LIN, CHUN HUIE, MD
N9730
LIN, DAVID LONG I, MD
P6018
LIN, FRANK Y, MD
P2891
LIN, TED TAI KU, MD
N6460
N7450
LIN, WEEI-CHIN, MD
LIN, WEI , MD
P2892
LIN, YANN-BOR, MD
N1737
N4557
P1780
LIN, YUEZHEN , MD
LIN, ZUORONG, MD
LINCOLN, CHRISTIE MARY, MD
P0756
N9894
LINCOLN, JEWEL CATHERINE, DO
LINCOLN, JOHN ANIL, MD
8/15/2011
6/3/2011
6/3/2016 NEUROLOGY
N5194
LINDEMANN, CAREY JYNETTE, MD
2/5/2010
P7149
LINDLE, KATHERINE ALEXIS, MD
7/1/2013
7/1/2018 CARDIOLOGY
Secondary Specialty
(Self-Designated)
PEDIATRICS
PALLIATIVE
MEDICINE
Practice City
PEDIATRICS
Disciplinary
Status Date
5/3/2012 None
N/A
FORT WORTH TX
ACTIVE
11/30/2011 None
N/A
HOUSTON
TX
ACTIVE
4/12/2013 None
N/A
BURNET
TX
ACTIVE
7/4/2013 None
N/A
ACTIVE
8/9/2011 None
N/A
ACTIVE
6/19/2012 None
N/A
ACTIVE
5/3/2013 None
N/A
TX
HOUSTON
TX
ACTIVE
5/17/2012 None
N/A
HOUSTON
TX
ACTIVE
5/24/2011 None
N/A
HOUSTON
TX
ACTIVE
4/5/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/20/2012 None
N/A
6/4/2010 None
8/26/2010 None
N/A
N/A
4/13/2012 None
N/A
12/29/2008 None
11/13/2009 None
1/10/2012 None
N/A
N/A
N/A
8/15/2011 None
6/13/2011 None
N/A
N/A
2/5/2010 None
N/A
7/12/2013 None
N/A
GALVESTON
HEMATOLOGY INTERNAL MEDICINE
TX
LICENSE
ISSUED
HOUSTON
NORMAN
TX
OK
HOUSTON
TX
NEURO-RADIOLOGY
PEDIATRICS,
CARDIOLOGY
Page 155 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
AUSTIN
CARDIOLOGY
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
6/15/2011
UROGYNECOLOGY
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
5/2/2011
6/3/2013
EMERGENCY
6/1/2012
6/1/2017 MEDICINE
6/1/2012
8/29/2008
8/29/2013 PAIN MEDICINE
PEDIATRICS,
8/16/2010
PULMONARY
CRITICAL CARE
2/1/2013
2/1/2018 MEDICINE
INTERNAL MEDICINE
EMERGENCY
8/1/2011
8/1/2016 MEDICINE
P0082
LINDO, FIONA M, MD
N3839
N9591
P6859
LINDSAY, JEROME ALLEN II, MD
LINDSAY, JOHN KRISTIAN, MD
LINGAM, PRANATHI , MD
P3378
P3379
N0928
LINGAN, CHRISTOPHER C, MD
LINGAPPAN, KRITHIKA , MD
LINN, ANDREW , MD
N7451
LIOU, AIMEE , MD
P5410
LIOU, ROBERT DAR TEH, MD
P0625
N7131
LIPPMANN, MELANIE JILL, MD
LITCHFIELD, CHRISTOPHER
TERRENCE, MD
N7452
N9465
LITREL, MICHAEL JOSEPH, MD
LITTLE, JENELLE EDEN, MD
8/16/2010
4/15/2011
OBSTETRICS &
GYNECOLOGICAL
8/16/2015 SURGERY
P1781
P6672
LITTLE, KATHRYN ELIZABETH, MD
LITTRELL, LAUREL A, MD
1/2/2012
5/15/2013
5/15/2018 RADIOLOGY
P5670
P0626
LITVAK, STANLEY JAMES, MD
LIU, CHRISTINE Y, MD
3/1/2013
8/1/2011
P0627
LIU, DONGXIN, MD
8/1/2011
P1782
LIU, HENRY, MD
1/2/2012
P5102
LIU, HONGBO, MD
12/17/2012
P5102
LIU, HONGBO, MD
12/17/2012
P5102
N6913
LIU, HONGBO, MD
LIU, JING, MD
12/17/2012
7/1/2010
7/15/2010
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
BREAST IMAGING
3/1/2018 RADIOLOGY
HEMATOLOGY/ONCOL
8/1/2016 OGY
INTERNAL MEDICINE
ORTHOPEDIC
12/17/2017 SURGERY
ORTHOPEDIC
12/17/2017 SURGERY
ORTHOPEDIC
12/17/2017 SURGERY
7/1/2015 PATHOLOGY
Page 156 of 300
Disciplinary
Status Date
6/15/2011 None
N/A
9/10/2009 None
5/26/2011 None
6/28/2013 None
N/A
N/A
N/A
6/1/2012 None
6/4/2012 None
10/20/2008 None
N/A
N/A
N/A
DENISON
TEMPLE
TX
TX
HOUSTON
TX
HOUSTON
TX
ACTIVE
9/8/2010 None
N/A
ORANGE
CA
ACTIVE
2/5/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
8/9/2011 None
N/A
7/15/2010 None
N/A
ACTIVE
ACTIVE
9/23/2010 None
4/20/2011 None
N/A
N/A
ACTIVE
ACTIVE
1/12/2012 None
5/28/2013 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/6/2013 None
8/29/2011 None
N/A
N/A
8/1/2011 None
N/A
1/2/2012 None
N/A
FAMILY PRACTICE
ROCHESTER MN
POUGHKEEPS
IE
NY
AUSTIN
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
FULTON
KY
ACTIVE
12/27/2012 None
N/A
FULTON
KY
ACTIVE
12/27/2012 None
N/A
FULTON
UNIONDALE
KY
NY
ACTIVE
ACTIVE
12/27/2012 None
7/16/2010 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
ANATOMIC
4/12/2013
4/12/2018 PATHOLOGY
12/12/2008
HEMATOLOGY/ONCOL
6/15/2011
6/15/2016 OGY
NEUROLOGICAL
2/1/2012
2/1/2017 SURGERY
6/3/2013
EMERGENCY
6/15/2011
6/15/2016 MEDICINE
PHYSICAL MED. &
4/9/2010
P2141
LIU, LI-HERNG, MD
P6211
N1739
LIU, LINA, MD
LIU, YINGHUI , MD
P0083
LIU-DUMLAO, THERESA ONG, MD
P2029
P6860
LIVINGSTON, ANDREW DALE, MD
LIWAG, NOAH ABILLE, MD
P0084
LIZARDI, PABLO L, MD
N5816
LLANOS, RAUL MAURICIO, DO
N5198
N8212
2/5/2010
12/1/2010
P2287
LLAVE, ALFRED DE CASTRO, MD
LLEMIT, SHARIFA , MD
LLOREN, CHARISSE CASTELLANO,
MD
P3380
N9092
LLUBERES, NUBIA GEYSSELL, MD
LO, STEVEN W, MD
6/1/2012
3/15/2011
N9731
P1348
LOCASCIO, EDWARD JOHN, MD
LOCKER, MATTHEW JAMES, MD
LOCKRIDGE, JOSEPH BRENDAN,
MD
5/16/2011
11/4/2011
N8418
3/1/2012
1/3/2011
N6915
LODHA, ANAND KUMAR, MD
7/1/2010
TM00494 LOEFFLER, PAUL MARK, MD
12/15/2011
N1740
LOFTIS, BRENT , DO
12/12/2008
N9896
LOGAN, JOHN WELLS III, MD
P6212
N9898
LOH, JOHN CHUCH SHENG, MD
LOHIYA, PIYUSH SURESH, MD
6/3/2011
4/12/2013
6/3/2011
TX
TX
INTERNAL MEDICINE
HOUSTON
TX
SAN ANTONIO TX
6/1/2017 PSYCHIATRY
EMERGENCY
5/16/2016 MEDICINE
11/4/2016 RADIOLOGY
LODEIRO, JORGE GABRIEL, MD
ACTIVE
CYTOPATHOLOGY
TEMPLE
3/1/2017 PEDIATRICS
P0085
Practice City
ANESTHESIOLOGY
2/5/2015 RADIOLOGY
MATERNAL AND
COLON AND RECTAL
7/1/2015 SURGERY
DIAGNOSTIC
6/15/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
HOUSTON
TX
KATY
HOUSTON
TX
TX
DALLAS
TX
OBSTETRICS AND
GYNECOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/21/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
4/19/2013 None
12/18/2008 None
N/A
N/A
6/15/2011 None
N/A
2/1/2012 None
6/12/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/20/2011 None
N/A
4/9/2010 None
N/A
2/5/2010 None
12/14/2010 None
N/A
N/A
3/14/2012 None
N/A
6/1/2012 None
4/4/2011 None
N/A
N/A
5/16/2011 None
11/17/2011 None
N/A
N/A
1/3/2011 None
N/A
6/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
GENERAL SURGERY DALLAS
TX
ACTIVE
7/27/2010 None
N/A
VISALIA
CA
ACTIVE
12/23/2011 None
N/A
DUNCANVILLE TX
ACTIVE
2/4/2009 None
N/A
ACTIVE
6/10/2011 None
N/A
ACTIVE
ACTIVE
4/23/2013 None
6/10/2011 None
N/A
N/A
DALLAS
TX
MUSCULOSKELETAL
4/12/2018 RADIOLOGY
IMAGING
MANCHESTER NH
6/3/2016 NEPHROLOGY
INTERNAL MEDICINE LAS VEGAS
NV
Page 157 of 300
License
Number
N5817
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
4/9/2010
N7715
N3150
LOMBANA-MARTINEZ, CLARA I, MD
LOMBOY, JUANITO QUINONES JR,
MD
LOMOTEY, CHAYLAH JOY, MD
9/15/2010
5/29/2009
N7830
LONGE, UCHEOMA NEBECHI, MD
10/1/2010
N8213
LONGEE, DARRYL CHARLES, MD
12/1/2010
P6861
LONGHOFER, LISA KAY, MD
6/3/2013
PEDIATRIC
HEMATOLOGY/ONCOL
12/1/2015 OGY
6/3/2018 SURGERY
N8214
LONGORIA, RODOLFO, MD
12/1/2010
N8028
LOONEY, WARREN HUNTER, MD
10/29/2010
N8317
LOPEZ, JOSUE EDWARD, MD
12/15/2010
P0849
N1742
LOPEZ, MARCO ANTONIO, MD
LOPEZ, MICHELLE ANN, MD
8/26/2011
12/12/2008
P7303
LOPEZ, RAUL JOSE, MD
7/15/2013
P6449
P4591
P4778
LOPEZ, SANDRA , MD
LOPEZ, SEBASTIAN , MD
LOPEZ-LLADO, SARA M, MD
5/1/2013
10/1/2012
11/1/2012
N8948
LOPEZ-ROMAN, ORLANDO A, MD
N1743
LOQUIAS, JESUS ARTHUR
PELONIA, MD
N5203
LOT, LUCY , MD
P7664
LOTT, FEYISETAN , DO
N9733
LOTT, NOAH THOMAS, MD
P3032
LOU, YANYAN , MD
3/1/2011
12/12/2008
2/5/2010
8/15/2013
5/16/2011
5/1/2012
EMERGENCY
12/15/2015 MEDICINE
Secondary Specialty
(Self-Designated)
Disciplinary
Status Date
FAMILY PRACTICE
HARLINGEN
TX
FAMILY PRACTICE
HOUSTON
TX
ACTIVE
10/7/2010 None
N/A
ACTIVE
12/21/2010 None
N/A
SAN ANTONIO TX
BROWNSVILL
E
TX
ACTIVE
6/11/2013 None
N/A
ACTIVE
12/7/2010 None
N/A
BAYTOWN
TX
ACTIVE
11/3/2010 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
1/20/2011 None
N/A
8/26/2011 None
1/30/2009 None
N/A
N/A
PEDIATRICS
ORTHOPEDIC
SURGERY
INTERNAL MED EMERGENCY MED
ADDICTION
MEDICINE - FP
HOSPITALIST
EL PASO
4/26/2010 None
N/A
9/15/2010 None
6/29/2009 None
N/A
N/A
TX
ACTIVE
8/7/2013 None
N/A
EL PASO
TX
ROSWELL
NM
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
5/8/2013 None
11/12/2012 None
12/3/2012 None
N/A
N/A
N/A
3/22/2011 None
N/A
3/12/2009 None
N/A
2/5/2010 None
N/A
8/15/2013 None
N/A
RICHMOND
IN
2/5/2015 PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ANESTHESIOLOGY
OBSTETRICS AND
5/1/2018 GYNECOLOGY
GASTROENTEROLOG
3/1/2016 Y
Practice City
Registration
Status of
Practice
Texas
State
License
COLLEGE
STATION
OBSTETRICS
HEMATOLOGY/ONCO
HOUSTON
Page 158 of 300
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
6/6/2011 None
N/A
TX
ACTIVE
5/8/2012 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CRITICAL CARE
PULMONARY
11/4/2011
MEDICINE
ABDOMINAL
4/1/2013
4/1/2018 GENERAL SURGERY SURGERY
K3313
LOUBE, DANIEL, MD
P6021
LOUGH, ERIK GREG, MD
N3151
P2031
LOVELACE, AKINYELE KAMAU , DO
LOVOI, JOSEPH JASPER JR, MD
N8119
N4560
11/15/2010
11/6/2009
N8215
LOW, BRANDON O'HARA, MD
LOW, LEAH ELIZABETH, MD
LOWE ECHEVARRIA, LINDA
ANGELA, DO
N2177
LOYD, JEFFERSON CARL, DO
2/6/2009
P5287
N0933
P0992
LOZANO, KRISTINA MARIE, MD
LU, LINGEN , MD
LU, LINH M, DO
5/29/2009
2/1/2012
12/1/2010
1/15/2013
8/29/2008
9/15/2011
L7021
LU, MING, MD
P3033
LUBBE, WILHELM , MD
N8809
LUCAS, ELENA , MD
2/15/2011
P6022
LUCAS, MIKAEL, MD
4/1/2013
P5546
LUCCHESE, CHRISTOPHER
FRANK, DO
LUCERO-UGALINO, LULITA
TAGUBA, MD
N5206
LUDWIG, DAVID R. , MD
P7152
P4779
LUE, JEFFREY , MD
LUGO, ESMERALDA , MD
N8681
LUGO, MANUEL, MD
LUJAN PALMA, JOSE ALFREDO,
MD
P1784
N7832
11/6/2009
5/1/2012
ORTHOPEDIC
11/15/2015 SURGERY
FAMILY
EMERGENCY
2/6/2014 MEDICINE
2/8/2013
2/4/2011
10/1/2010
11/17/2011 None
N/A
AUSTIN
TX
ACTIVE
4/17/2013 None
N/A
HEREFORD
TX
ACTIVE
ACTIVE
7/28/2009 None
2/20/2012 None
N/A
N/A
GALVESTON
GALVESTON
TX
TX
ACTIVE
ACTIVE
11/22/2010 None
1/5/2010 None
N/A
N/A
HOUSTON
TX
ACTIVE
1/4/2011 None
N/A
ACTIVE
1/22/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
2/4/2013 None
10/29/2008 None
9/19/2011 None
N/A
N/A
N/A
TX
ACTIVE
11/12/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
6/22/2012 None
N/A
2/15/2011 None
N/A
SPRING
7/1/2013
11/1/2012
ACTIVE
LACKLAND
AFB
TX
HOUSTON
TX
FORT WORTH TX
2/15/2016 PATHOLOGY
EMERGENCY
4/1/2018 MEDICINE
FP/OSTEO
MANIPULATION
MEDICINE
NUCLEAR
RADIOLOGY
2/5/2015 RADIOLOGY
ORTHOPEDIC
7/1/2018 SURGERY
PEDIATRIC EMER MED
2/4/2016 (PEDS)
PEDIATRICS
10/1/2015 NEUROLOGY
KATY
TX
ACTIVE
4/3/2013 None
N/A
SHERMAN
TX
ACTIVE
2/2/2012 None
N/A
MISHAWAKA
IN
ACTIVE
LICENSE
ISSUED
2/18/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/29/2013 None
11/5/2012 None
N/A
N/A
2/4/2011 None
N/A
10/26/2010 None
N/A
PLANO
ROSWELL
Page 159 of 300
Disciplinary
Status Date
CA
OPHTHALMOLOGY VITREOUS SURGERY TYLER
RADIATION
5/1/2017 ONCOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
SANTA ROSA
OTHER SPECIALTY
1/2/2012
2/5/2010
Practice City
Registration
Status of
Practice
Texas
State
License
TX
NM
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
P5547
LUKE, MANJU, DO
2/8/2013
P3383
LUM, ALBERT WAI-MING, MD
6/1/2012
N7833
P5103
P5103
P5103
LUMBRERAS, CHRISTINA B, MD
LUNA, JEFFREY LEE, MD
10/1/2010
12/17/2012
12/17/2012
12/17/2012
P7153
N3846
LUNA, RENE IMMANUEL, MD
LUNA-SALAZAR, CYNTHIA , MD
7/1/2013
8/21/2009
P7802
LUNG, JOHN, MD
8/30/2013
P6213
LUNSFORD, ALISON JOAN, MD
4/12/2013
P5548
LUNSFORD, JEROD, MD
2/8/2013
K5511
LUNSFORD, TISHA N, MD
2/5/2010
P3384
P7803
LUPO, PAMELA , MD
LUPTON, DREW TAYLOR, DO
6/1/2012
8/30/2013
GASTROENTEROLOG
2/5/2015 Y
INTERNAL MEDICINE
NEURODEVELOPMEN
TAL DISABILITIES
6/1/2017 (PEDIATRICS)
CHILD NEUROLOGY HOUSTON
H9368
LUQUETTE, MARK HENRY, MD
11/6/2009
PEDIATRIC
11/6/2014 PATHOLOGY
P6863
LUSINS, JOHN O III, MD
6/3/2013
N6466
LUU, HUNG S, MD
6/4/2010
N4562
LUY LOSSIO, GERMAN, MD
INTERNAL MEDICINE
GERIATRIC MEDICINE
FAMILY MEDICINE
EMERGENCY
10/1/2015 MEDICINE
OBSTETRICS AND
7/1/2018 GYNECOLOGY
INTERNAL MEDICINE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
PEDIATRIC
PEDIATRICS
EMERGENCY
2/8/2018 MEDICINE
Practice City
6/3/2018 PSYCHIATRY
TM00542 LY, JUSTIN, MD
5/15/2013
6/4/2015 PATHOLOGY
PULMONARY
CRITICAL CARE
11/6/2014 MEDICINE
DIAGNOSTIC
5/15/2018 RADIOLOGY
P0086
6/15/2011
LY, KEITH K, DO
11/6/2009
FORENSIC
PSYCHIATRY
HEMATOLOGY
(PATHOLOGY)
FORT WORTH TX
FORT WORTH TX
FORT WORTH TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
HOUSTON
HARLINGEN
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/8/2013 None
N/A
6/11/2012 None
N/A
10/1/2010
12/20/2012
12/20/2012
12/20/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
7/11/2013 None
10/2/2009 None
N/A
N/A
LICENSE
ISSUED
8/30/2013 None
N/A
AMARILLO
TX
ACTIVE
4/29/2013 None
N/A
AMARILLO
TX
ACTIVE
TEXAS
LICENSE
ISSUED
2/18/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
6/11/2012 None
9/4/2013 None
N/A
N/A
11/6/2009 None
N/A
ACTIVE
LICENSE
ISSUED
6/10/2013 None
N/A
6/4/2010 None
N/A
11/11/2009 None
N/A
GALVESTON
CORPUS
CHRISTI
POWAY
Page 160 of 300
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
TX
TX
TX
ACTIVE
CA
ACTIVE
LICENSE
ISSUED
7/3/2013 None
UNDER
BOARD
6/15/2011 ORDER
N/A
6/9/2011
License
Number
Physician Name
N8538
LYLES, JAMES EDWARD JR, MD
N8030
LYON, ALBERT WILFRED, MD
LYONS GAFFANEY, CECILIA
ANNSOFI, MD
N9256
P1350
P6999
N5820
P6214
N1749
P3192
MA, SHING-LU, MD
MABANTA, SHEILAINE RODRIGO,
MD
MACDONALD, BART ALLEN, MD
MACEDO, FRANCISCO YURI
BULCAO, MD
MACFARLANE, JOHN RALPH, MD
MACIAS CEDENO, FRANZ WILLIAM,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
HAND SURGERY 1/18/2011
1/18/2016 SURGERY
OBSTETRICS AND
10/29/2010
OBSTETRICS AND
MATERNAL AND
4/1/2011
4/1/2016 GYNECOLOGY
FETAL MEDICINE
CAMPBELL
ACTIVE
11/18/2011 None
N/A
4/12/2013
CARDIOLOGY
12/12/2008
6/14/2013
4/9/2010
5/15/2012
NEUROLOGICAL
8/21/2014 SURGERY
P0088
MACWAR, RACHID RYAN, MD
P0629
MADAIN, SAFI B, DO
8/1/2011
CARDIOVASCULAR
6/15/2016 DISEASES
EMERGENCY
8/1/2016 MEDICINE
N5211
MADANI, BAHAR, MD
2/5/2010
P0757
P6023
N7305
N/A
INTERNAL MEDICINE BAKERSFIELD CA
4/3/2009
MADHANI, NEAL BHAGWANJI, MD
MADHAVAN, RANGANATHAN
GURU, MD
MADNI, SYED A, MD
MAES, EARL BLAIR, MD
10/29/2010 None
RADIATION
6/14/2018 ONCOLOGY
NEUROLOGICAL
4/9/2015 SURGERY
11/4/2011
MACKENZIE, JOHN STUART, DO
P5411
N/A
N/A
H8736
MADARANG, ERIC LEE, DO
1/31/2011 None
4/7/2011 None
8/21/2009
10/1/2012
N8811
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
ACTIVE
MACIAS, MELISSA YVONNE, MD
MACK, TOREY L, MD
MADAPPA, TARUN, MD
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
CA
N3851
P4592
P3385
Registration
Status of
Practice
Texas
State
License
6/15/2011
6/1/2012
2/15/2011
2/1/2013
EMERGENCY
2/1/2018 MEDICINE
8/15/2011
4/1/2013
8/2/2010
8/2/2015 RADIOLOGY
DECATUR
TX
ACTIVE
6/19/2013 None
N/A
HOUSTON
TX
ACTIVE
5/3/2010 None
N/A
MIAMI
FL
ACTIVE
4/15/2013 None
N/A
TX
ACTIVE
1/21/2009 None
N/A
BROOKLYN
CORPUS
CHRISTI
HOUSTON
NY
ACTIVE
5/18/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
8/26/2009 None
10/3/2012 None
N/A
N/A
ROWLETT
TX
ACTIVE
LICENSE
ISSUED
10/14/2009 None
N/A
6/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/3/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/26/2012 None
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
2/5/2013 None
N/A
8/15/2011 None
4/5/2013 None
8/23/2010 None
N/A
N/A
N/A
GENERAL SURGERY BURNET
NEUROLOGICAL
SURGERY
NEONATOLOGY
EMERGENCY
MEDICINE
INTERNAL MEDICINE
BATON
ROUGE
PULMONARY
CRITICAL CARE
MEDICINE
HOSPITALIST
HOSPITALIST
Page 161 of 300
CORPUS
CHRISTI
LA
TX
PITTSBURGH
PA
DANBURY
NIXA
CT
MO
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
P2896
Physician Name
MAGADAN, ALEJANDRO ALFONSO,
MD
N5823
MAGAT, ELAINE MAGDARAOG, MD
K9339
MAGDY, KHALED RATEB, MD
P1667
MAGEE, JEFFREY A, MD
N7558
MAGEL, GEORGE DIMITRI, MD
8/27/2010
N4567
MAGNO, FERDINAND LYNDON, MD
11/6/2009
N5212
MAGSINO, NANCY AGUILAR, MD
4/13/2012
4/9/2010
2/15/2011
12/15/2011
2/5/2010
4/13/2017 NEUROLOGY
PHYSICAL MED. &
Secondary Specialty
(Self-Designated)
VASCULAR
NEUROLOGY
PULMONARY
CRITICAL CARE
2/15/2016 MEDICINE
MEDICINE (IM)
PEDIATRIC
HEMATOLOGY/ONCOL
12/15/2016 OGY
DERMATOLOGIC
SURGERY
OBSTETRICS &
GYNECOLOGICAL
2/5/2015 SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
BETHESDA
MD
ACTIVE
4/20/2012 None
N/A
HOUSTON
TX
4/27/2010 None
N/A
DAYTON
TX
ACTIVE
TEXAS
LICENSE
ISSUED
2/15/2011 None
N/A
DALLAS
TX
ACTIVE
12/22/2011 None
N/A
HOUSTON
TX
ACTIVE
9/17/2010 None
N/A
SAN BENITO
TX
ACTIVE
12/17/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
4/20/2010 None
N/A
ACTIVE
ACTIVE
1/12/2012 None
10/17/2012 None
N/A
N/A
LICENSE
ISSUED
N5825
MAHADEVA, BRANAVEN, MD
P1668
P4593
MAHALINGAM, DEVALINGAM , MD
MAHAND, JENNIFFIER M, MD
12/15/2011
10/1/2012
12/15/2016 ONCOLOGY
NEUROMUSCULAR
DISEASE
HEMATOLOGY/ONCO
LOGY
SAN ANTONIO TX
BAYTOWN
TX
P5104
MAHLMANN, MICHAEL RAY, MD
12/17/2012
TX
ACTIVE
1/1/2013 None
N/A
P5104
12/17/2012
TX
ACTIVE
1/1/2013 None
N/A
P5104
12/17/2012
TX
N/A
MAHMOOD, USAMA , MD
ACTIVE
LICENSE
ISSUED
1/1/2013 None
P3035
RADIATION
5/1/2017 ONCOLOGY
5/1/2012 None
N/A
4/9/2010
5/1/2012
4/9/2015 NEUROLOGY
N3852
MAHMUD, HINA, MD
8/21/2009
P1352
11/4/2011
N4569
MAI, FLOWER HOANG, DO
MAIDA, MAHAMADU ABDULFATAHU, MD
ENDOCRINOLOGY,
DIABETES AND
11/6/2009
N8813
N7453
MAILLOUX, BREION , DO
MAINALI, DINESH, MD
2/15/2011
8/16/2010
GERIATRICS INTERNAL MEDICINE FOREST PARK IL
ACTIVE
9/23/2009 None
N/A
SULPHUR
INTERNAL MEDICINE SPRINGS
TX
ACTIVE
11/10/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
11/16/2009 None
N/A
2/15/2011 None
8/23/2010 None
N/A
N/A
HUMBLE
INTERNAL MEDICINE WESTFIELD
Page 162 of 300
MA
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
L8424
MAIORIELLO, ANTHONY VITO, MD
6/4/2010
N5828
MAJID, HASHIR , MD
4/9/2010
NEUROLOGICAL
6/4/2015 SURGERY
CRITICAL CARE
4/9/2015 MEDICINE
N9737
MAJKA, CHRISTOPHER PAUL, MD
5/16/2011
N2637
P0431
P2033
4/3/2009
7/15/2011
2/1/2012
P1099
MAJOR, JAMES CALDER JR, MD
MAJUMDAR, AYANAVA, MD
MAKADIA, PARIN M, MD
MAKAM, RAGHAVENDRA CHARAN
PARTHASARATHI, MD
2/1/2017 NEPHROLOGY
10/3/2011
P7497
P4480
MAKEY, IAN ANDREW, MD
MAKHLOUF, TONY , MD
8/1/2013
9/17/2012
N9899
MAKIA, AYUK, MD
6/3/2011
P7154
MAKINDE, EDILEOLA, MD
7/1/2013
N1752
MAKISHIMA, TOMOKO , MD
P2292
P0758
MAKKAR, AKASH, MD
MAKOHONIUK, LESLIE WILLIAM,
MD
N8033
P3195
N9467
MALANI, SEEMA, MD
MALAVE, SAMANTHA D, MD
MALAVE, VICTOR BRIAN, MD
P0432
P6455
MALBAS, ANTONIO CABRERA, MD
MALDONADO, PEDRO ANTONIO,
MD
N5214
MALHOTRA, ADVITYA , MD
2/5/2010
N7836
N7455
P7307
MALHOTRA, MINNI, MD
MALIAKKAL, MAMMEN , MD
MALIK, AMYN, MD
10/1/2010
8/16/2010
7/15/2013
12/12/2008
3/1/2012
DAVENPORT
HOUSTON
INTERNAL MEDICINE PALESTINE
INTERNAL MEDICINE
HENDERSON
BALTIMORE
10/29/2010
5/15/2012
4/15/2011
OBSTETRICS AND
5/1/2018 GYNECOLOGY
Disciplinary
Status Date
6/4/2010 None
N/A
4/9/2010 None
N/A
ACTIVE
5/24/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/14/2009 None
7/22/2011 None
2/10/2012 None
N/A
N/A
N/A
TX
ACTIVE
10/13/2011 None
N/A
8/6/2013 None
12/5/2012 None
N/A
N/A
6/3/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
MD
ACTIVE
8/7/2013 None
N/A
TX
ACTIVE
12/17/2008 None
N/A
MI
ACTIVE
3/6/2012 None
N/A
LINCOLN
NE
8/18/2011 None
N/A
DICKINSON
HOUSTON
CORPUS
CHRISTI
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
10/29/2010 None
5/22/2012 None
5/2/2011 None
N/A
N/A
N/A
TX
ACTIVE
8/11/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
5/8/2013 None
N/A
2/5/2010 None
N/A
10/1/2010 None
8/24/2010 None
8/14/2013 None
N/A
N/A
N/A
INTERNAL MEDICINE
UROGYNECOLOGY
DALLAS
GASTROENTEROLOG
Y
FAMILY PRACTICE
8/16/2015 INTERNAL MEDICINE PEDIATRICS
Page 163 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
HOSPITALIST
RIO RANCHO NM
OTORHINOLARYNGO
LOGY
GALVESTON
CARDIAC
ELECTROPHYSIOLOG CARDIOVASCULAR
3/1/2017 Y
DISEASES
ANN ARBOR
5/1/2013
Practice City
CORPUS
CHRISTI
OBSTETRICS AND
7/1/2018 GYNECOLOGY
8/15/2011
7/15/2011
Secondary Specialty
(Self-Designated)
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
PULMONARY
MEDICINE
Registration
Status of
Practice
Texas
State
License
TEXAS
LICENSE
IA
ISSUED
LICENSE
ISSUED
AUSTIN
GRAPEVINE
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N6470
MALIK, ANUJ , MD
6/4/2010
N3159
MALIK, JAMIL AYUB, MD
5/29/2009
PHYSICAL MED. &
INTERVENTIONAL
P5675
MALIK, ATIF BABAR, MD
3/1/2013
P0994
N3856
MALIK, MOHAMMAD IBRAHIM, MD
MALIK, NITIN, MD
9/15/2011
8/21/2009
P6024
4/1/2013
P7000
P0995
P1100
N3858
MALIK, OSMAN , MD
MALIREDDY, KISHORE KUMAR
REDDY , MD
MALIYIL, JEPSIN ANAT, MD
MALL, SANJEEV KUMAR, MD
MALLADI, PREETI , MD
6/14/2013
9/15/2011
10/3/2011
8/21/2009
6/14/2018
9/15/2016
10/3/2016
8/21/2014
P6674
MALONE, LOREN, MD
5/15/2013
J6560
MALONE, MARK STEVEN, MD
N7456
N0942
P0089
MALPANI, VISHAL BHAGCHAND,
MD
MALSAM, ERIC JOHN, MD
MALYA, ROHITH RAMACHANDRA,
MD
2/5/2010
8/16/2010
8/29/2008
6/15/2011
N0943
MAMIGONIAN, JACQUES , MD
P3037
P0252
MAMILLAPALLI, PADMAJA DEVI, MD
MAMMEN, TONY, MD
5/1/2012
7/1/2011
P3386
MANASA, POONAM MEHTA, MD
6/1/2012
N5218
MANDALAPU, VIJAYA LAKSHMI, MD
2/5/2010
P0632
MANDAVA, ANEEL, MD
MANDAYAM, SREEDHAR AMMANJI,
MD
8/1/2011
N3861
8/29/2008
8/21/2009
GENERAL SURGERY
FAMILY MEDICINE
FAMILY MEDICINE
GENERAL SURGERY
Secondary Specialty
(Self-Designated)
PAIN MANAGEMENT
CARDIOVASCULAR
DISEASES
HOSPITALIST
PSYCHIATRY
PULMONARY
CRITICAL CARE
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
PHYSICAL MED. &
OBSTETRICS AND
2/5/2015 GYNECOLOGY
UROGYNECOLOGY
INTERVENTIONAL
DIAGNOSTIC
8/1/2016 RADIOLOGY
RADIOLOGY
6/4/2010 None
N/A
ACTIVE
4/3/2013 None
N/A
TX
ACTIVE
6/16/2009 None
N/A
WACO
AUSTIN
TX
TX
ACTIVE
ACTIVE
10/17/2011 None
9/1/2009 None
N/A
N/A
FALLS
CHURCH
VA
ACTIVE
4/8/2013 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TX
EMERGENCY
6/15/2016 MEDICINE
Disciplinary
Status Date
FORT SAM
HOUSTON
DALLAS
PEDIATRIC CRITICAL
CARE MEDICINE
DALLAS
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Registration
Status Date
Disciplinary
Status of
Texas
License
TEMPLE
AUSTIN
TX
TX
7/3/2013
10/28/2011
10/14/2011
8/26/2009
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
5/20/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/2/2010 None
9/9/2008 None
N/A
N/A
6/15/2011 None
N/A
MADISONVILL
E
TX
ACTIVE
10/13/2008 None
N/A
BRYN MAWR
ARLINGTON
ACTIVE
ACTIVE
6/1/2012 None
7/12/2011 None
N/A
N/A
6/8/2012 None
N/A
2/5/2010 None
N/A
8/1/2011 None
N/A
8/26/2009 None
N/A
Page 164 of 300
PA
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
License
Number
Physician Name
N4573
MANDLIK, NANDINI ANANYA, DO
MANDYAM, SRINAND ANANDAM,
P6864
MD
dicaid
dicaid
Agreement
End Date
Designated)
11/6/2009
6/3/2013
Secondary Specialty
(Self-Designated)
KILLEEN
P3387
MANEK, NEIL RAMESH, MD
6/1/2012
N9595
N9900
5/2/2011
6/3/2011
6/3/2016 NEUROLOGY
P3197
MANGAT, MANPREET, MD
MANI, RANJEETA, MD
MANJAPPA, NAGARATHNA
GOWDA, MD
N5219
MANJUNATH, GURUPRASAD, MD
2/5/2010
P2726
MANKAN, NAGENDER, MD
4/2/2012
P2727
MANKIDY, BABITH JOSEPH, MD
4/2/2012
P3647
MANKIN, SARAH ASHLEY, DO
6/15/2012
N3162
MANN, MICHAEL THOMAS, MD
5/29/2009
2/5/2015 NEPHROLOGY
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
4/2/2017 OGY
EL PASO
PULMONARY
CRITICAL CARE
OSTEO
MANIPULATIVE
MEDICINE
LUBBOCK
EMERGENCY
5/29/2014 MEDICINE
AUSTIN
P5415
P4481
N4574
MANN, SHANNON ELIZABETH, DO
MANNE, HARI KRISHNA, MD
MANNING, TESSA LEIGH, MD
MANONGAS, MARIA AURORA
RAYPON, MD
MANOUKIAN, GEORGE EDWARD,
MD
MANSOOR, SABA, MD
2/1/2013
9/17/2012
11/6/2009
2/1/2018 PATHOLOGY
11/4/2011
7/15/2011
8/15/2011
P1354
P0434
P0760
P5550
MANSOOR, TARIQ , MD
P1565
MANSOUR, ALFRED AMEEN III, MD
P5417
MANSOURKHANI, SHIVA , MD
5/15/2012
2/8/2013
12/1/2011
2/1/2013
PEDIATRIC
CHILD AND
ADOLESCENT
2/1/2018 PSYCHIATRY
NEPHROLOGY
PULMONARY
CRITICAL CARE
MEDICINE
SLEEP MEDICINE
Registration
Status of
Practice
Texas
Practice City
State
License
PLEASANTON TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
6/6/2013 None
N/A
6/1/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/14/2011 None
6/10/2011 None
N/A
N/A
5/15/2012 None
N/A
2/5/2010 None
N/A
ACTIVE
4/6/2012 None
N/A
ACTIVE
4/5/2012 None
N/A
TX
ACTIVE
6/18/2012 None
N/A
TX
ACTIVE
6/16/2009 None
N/A
2/14/2013 None
10/8/2012 None
11/13/2009 None
N/A
N/A
N/A
11/4/2011 None
N/A
THE
WOODLANDS TX
DETROIT
MI
INTERNAL MEDICINE
HOSPITALIST
FARGO
DALLAS
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
PSYCHIATRY
Page 165 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
11/24/2009 None
N/A
TX
ND
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
ACTIVE
7/20/2011 None
8/23/2011 None
N/A
N/A
GALVESTON TX
GREEENWOO
D VILLAGE
CO
ACTIVE
2/21/2013 None
N/A
ACTIVE
12/6/2011 None
N/A
ACTIVE
2/25/2013 None
N/A
License
Number
Physician Name
P2487
MANTHENA, SWAPNA, MD
N5220
MANUEL, JACOB BENJAMIN, MD
MANZANO, JOANNA GRACE MAYO,
MD
P6026
dicaid
dicaid
Agreement
End Date
Designated)
3/15/2012
2/5/2010
4/1/2013
N8034
MANZAR, SHABIH, MD
10/29/2010
N7457
P6216
MANZI, SUZANNE MARIE, MD
MANZOUL, SAAD MAHMOUDADAM, MD
N1387
N3863
P5678
MANZURI, SHAI , MD
MAO, QINWEN , MD
MAPAKSHI, NANDANA, MD
P6865
MAPES, KENNETH LEROY, MD
N7458
MAPOSA, DOUGLAS , MD
8/16/2010
P7665
P0633
MARAKATHAM, SREEDEVI, MD
MARANCENBAUM, ARIE , MD
8/15/2013
8/1/2011
N5221
MARCELLO, ALTON , MD
N8815
MARCIANO, DENISE K, MD
P2728
MARCUM, BENJAMIN AUSTIN, MD
PHYSICAL MED. &
4/12/2013
4/12/2018 RADIOLOGY
6/3/2013
2/5/2010
2/15/2011
4/2/2012
8/21/2014 PATHOLOGY
EMERGENCY
6/3/2018 MEDICINE
PEDIATRIC ANES
8/16/2015 (PEDS)
HOUSTON
NEONATALPERINATAL
MEDICINE
PAIN
MANAGEMENT/REHA
B MED
LANSING
MUSCULOSKELETAL
RADIOLOGY
PLANO
CRITICAL CARE
MEDICINE
DALLAS
DALLAS
NEPHROLOGY
OBSTETRICS AND
2/5/2015 GYNECOLOGY
GENERAL PRACTICE
INTERNAL MEDICINE
TX
FP/OSTEO
MANIPULATION
MEDICINE
MAREN, CHRISTINE , DO
7/15/2011
P1101
MARFATIA, RINA SUDHIR, MD
MARIANO, MARIA RIZZA DELIZO,
MD
MARINA, SHADI, MD
10/3/2011
INFECTIOUS
10/3/2016 DISEASES
3/15/2013
4/2/2012
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
3/15/2012 None
N/A
2/5/2010 None
N/A
4/18/2013 None
N/A
10/29/2010 None
N/A
MI
ACTIVE
9/9/2010 None
N/A
TX
ACTIVE
4/19/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
10/15/2008 None
8/26/2009 None
4/11/2013 None
N/A
N/A
N/A
GENOA
OH
ACTIVE
6/19/2013 None
N/A
HOUSTON
TX
8/24/2010 None
N/A
BAYTOWN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
8/15/2013 None
8/19/2011 None
N/A
N/A
2/5/2010 None
N/A
2/15/2011 None
N/A
4/2/2012 None
N/A
ACTIVE
7/20/2011 None
N/A
P0436
P5840
P2729
Practice City
ORTHOPEDIC
2/5/2015 SURGERY
8/16/2010
10/10/2008
8/21/2009
3/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
SAN ANTONIO TX
TX
ACTIVE
11/15/2011 None
N/A
HOSPITALIST
IL
ACTIVE
ACTIVE
3/20/2013 None
4/9/2012 None
N/A
N/A
Page 166 of 300
ROCKFORD
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N0945
MARINESCU, RODICA CATRINEL,
MD
8/29/2008
N3866
MARINO, MICHELLE , MD
8/21/2009
P1102
MARKAN, SANDEEP, MD
10/3/2011
P3038
MARKO, NICHOLAS FRANK, MD
P3648
MARKS, LATOIA MONNEQUE, MD
6/15/2012
P5206
1/4/2013
N1389
P3039
MARKS, SONYA DENISE, MD
MARMOL-VELEZ, JUAN
ALEJANDRO, MD
MAROULES, CHRISTOPHER
DANIEL, MD
MARQUART, PRECIOUS JEWEL,
MD
MARQUEZ, AMES TADEO, MD
M3011
MARR, JONATHAN K, MD
N8950
N9738
N9597
N7138
MARRERO, DERIK IVAN, MD
MARRIOTT, KENNETH ARMISTICE
III, MD
MARROCCO, CHRISTOPHER
JULIAN, MD
N3867
P0437
N8121
5/1/2012
3/1/2011
5/16/2011
10/10/2008
5/1/2012
5/1/2013
5/2/2011
11/15/2010
Secondary Specialty
(Self-Designated)
PEDIATRIC ANES
8/21/2014 (PEDS)
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
NEUROLOGICAL
CRITICAL CARE 5/1/2017 SURGERY
NEUROSURGERY
OBSTETRICS AND
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
1/4/2018 GYNECOLOGY
3/1/2016 CARDIOLOGY
DIAGNOSTIC
5/16/2016 RADIOLOGY
5/1/2017 PSYCHIATRY
PEDIATRIC
EMERGENCY
PLASTIC &
RECONSTRUCTIVE
5/2/2016 SURGERY
EMERGENCY
11/15/2015 MEDICINE
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
9/16/2008 None
N/A
SAN ANTONIO TX
ACTIVE
9/14/2009 None
N/A
MILWAUKEE
WI
ACTIVE
10/14/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
5/3/2012 None
N/A
6/15/2012 None
N/A
TX
ACTIVE
2/11/2013 None
N/A
URGENT CARE
MEDICINE
DALLAS
TX
ACTIVE
3/16/2011 None
N/A
ACTIVE
5/20/2011 None
N/A
TX
ACTIVE
ACTIVE
10/31/2008 None
5/23/2012 None
N/A
N/A
FORT WORTH TX
ACTIVE
5/9/2013 None
N/A
DALLAS
LACKLAND
AFB
TX
ACTIVE
6/15/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
11/22/2010 None
N/A
7/15/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
9/4/2009 None
N/A
7/15/2011 None
N/A
4/9/2010 None
N/A
8/30/2013 None
N/A
8/28/2009 None
N/A
HOUSTON
BURLESON
7/15/2010
MARROQUIN, JACLYN TERESA, MD
8/21/2009
7/15/2011
N5839
MARSH, DAVID GEORGE JR, MD
MARSHALL, KELLEY WOODRUFF,
MD
P7806
MARSHALL, LINDSAY ANNE, DO
8/30/2013
N3868
MARSILLO, KRISTY MARIE , DO
8/21/2009
ORTHOPEDIC
7/15/2016 SURGERY
DIAGNOSTIC
4/9/2015 RADIOLOGY
EMERGENCY
8/30/2018 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
4/9/2010
Practice City
Registration
Status of
Practice
Texas
State
License
PEDIATRIC
RADIOLOGY
AUSTIN
Page 167 of 300
TX
ACTIVE
License
Number
Physician Name
P7499
MARTE, MICHAEL, MD
N5223
MARTENS, HAL FREDRICK, DO
N8539
MARTI, JON K, DO
P2296
MARTIN, AMY RUTH, MD
P7309
MARTIN, DONALD JOSEPH, MD
P7500
MARTIN, ERIC BRANDON, MD
N7140
MARTIN, JASON LEE, MD
N9739
P6217
N7944
MARTIN, JASON MICHAEL, MD
MARTIN, JOHN MATTHEW IV, MD
MARTIN, JOSHUA GORDON, MD
N9261
P5551
MARTIN, KAHLIL JUSTIN, MD
MARTIN, LANCE STEVEN, MD
N6475
MARTIN, MICHAEL COLIN, MD
P1566
MARTIN, PATRICIA, MD
N5841
MARTINCHECK, DAVID J., MD
MARTINEZ GAMBA, GERMAN
NICOLAS, MD
P5680
N5844
P6458
MARTINEZ IRIZARRY, AXEL E, MD
MARTINEZ TORRES, CARLO OBET,
MD
P6219
MARTINEZ, ADRIANA , MD
P7501
N6477
Registration
dicaid
dicaid
Status of
Agreement
Practice
Texas
Start Date
End Date
Designated)
(Self-Designated)
Practice City
State
License
HEMATOLOGY/ONCOL
8/1/2013
8/1/2018 OGY
ACTIVE
LICENSE
2/5/2010
ISSUED
OCEAN
1/18/2011
1/18/2016 RADIOLOGY
SPRINGS
MS
ACTIVE
EMERGENCY
3/1/2012
3/1/2017 MEDICINE
ACTIVE
GASTROENTEROLOG
LICENSE
7/15/2013
7/15/2018 INTERNAL MEDICINE Y
ISSUED
LICENSE
8/1/2013
ISSUED
LICENSE
7/15/2010
AUSTIN
TX
ISSUED
EMERGENCY
5/16/2011
5/16/2016 MEDICINE
KILLEEN
TX
ACTIVE
4/12/2013
SAN ANTONIO TX
ACTIVE
10/15/2010
TEXARKANA
TX
ACTIVE
LICENSE
4/1/2011
ISSUED
2/8/2013
FAMILY MEDICINE
LUBBOCK
TX
ACTIVE
LICENSE
6/4/2010
ISSUED
DIAGNOSTIC
12/1/2011
12/1/2016 RADIOLOGY
NEURO-RADIOLOGY FOGELSVILLE PA
ACTIVE
LICENSE
4/9/2010
ISSUED
3/1/2013
ACTIVE
4/9/2010
5/1/2013
4/12/2013
MARTINEZ, BRENDA NOEMI, MD
8/1/2013
8/1/2018 PEDIATRICS
MARTINEZ, DORA ALICIA, MD
6/4/2010
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
CARDIOVASCULAR
SURGERY
FAMILY MEDICINE
Page 168 of 300
DIMMITT
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
9/2/2013 None
N/A
2/5/2010 None
N/A
1/21/2011 None
N/A
3/15/2012 None
N/A
7/15/2013 None
N/A
8/1/2013 None
N/A
7/15/2010 None
N/A
5/24/2011 None
4/16/2013 None
10/20/2010 None
N/A
N/A
N/A
4/1/2011 None
2/14/2013 None
N/A
N/A
6/4/2010 None
N/A
12/6/2011 None
N/A
4/9/2010 None
N/A
3/6/2013 None
N/A
4/16/2010 None
N/A
5/1/2013 None
N/A
4/12/2013 None
N/A
8/1/2013 None
N/A
6/4/2010 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS &
GYNECOLOGICAL
10/1/2010
10/1/2015 SURGERY
EMERGENCY
2/1/2013
2/1/2018 MEDICINE
N7837
MARTINEZ, IVVANEE , MD
P5418
MARTINEZ, JOSE LUIS JR, MD
P0091
N8036
P5679
MARTINEZ, JUAN DIEGO, MD
MARTINEZ, MARTE AQUILES JR,
MD
MARTINEZ, MICHAEL JOEL, MD
10/29/2010
3/1/2013
P7502
N7945
MARTINEZ, OSCAR JR, MD
MARTINEZ, RAUL SOSA, MD
8/1/2013
10/15/2010
N5842
MARTINEZ, ROBERT ERIC, MD
N7459
MARTINEZ, RODOLFO RANDY, DO
N5843
MARTINEZ, SYLVIA AMADOR, MD
MARTINEZ-MADRIGAL, EZEQUIEL,
P1895
MD
MARTINEZ-MARTINEZ, ZARAGOZA,
AM00001 MD
MARTINEZ-OCHOA, JOSE
P0093
RODRIGO, MD
N3870
N5224
MARTINI, WISAM , MD
MARTIRENA, MARGARITA EMILIA,
MD
6/15/2011
4/9/2010
EMERGENCY
4/9/2015 MEDICINE
8/16/2010
4/9/2010
6/15/2011
ACTIVE
10/4/2010 None
N/A
HUMBLE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
2/15/2013 None
N/A
6/15/2011 None
N/A
10/29/2010 None
3/25/2013 None
N/A
N/A
8/1/2013 None
10/21/2010 None
N/A
N/A
5/3/2010 None
N/A
8/16/2010 None
N/A
4/9/2010 None
N/A
1/17/2012 None
N/A
10/1/2010 None
N/A
6/21/2011 None
N/A
TX
ANESTHESIOLOGY
OTHER SPECIALTY
INTERVENTIONAL
CARDIOLOGY
TX
MARUVADA, SREEKAR , MD
8/21/2009
N6479
N9740
P6676
MARVIN, ANDREA STEPHANIE, MD
MARX, DOUGLAS PETE, MD
MARX, JULIE ERICA, MD
6/4/2010
5/16/2011
5/15/2013
6/4/2015 UROLOGY
NY
ACTIVE
LANCASTER
OH
ACTIVE
LICENSE
ISSUED
9/4/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/28/2009 None
N/A
6/4/2010 None
5/19/2011 None
6/12/2013 None
N/A
N/A
N/A
N6480
P0996
F9784
MARZOUK, MICHAEL F, MD
MASAND, RAMYA PRAKASH, MD
MASEK, JEANETTE L, MD
6/4/2010
9/15/2011
8/16/2010
9/15/2016 PATHOLOGY
6/4/2010 None
9/20/2011 None
8/30/2010 None
N/A
N/A
N/A
LAKE
JACKSON
TX
HOUSTON
DALLAS
TX
TX
HOUSTON
KERRVILLE
TX
TX
UROLOGIC SURGERY
HOSPITALIST
PEDIATRIC ANES
(PEDS)
Page 169 of 300
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
NEW YORK
N3871
Disciplinary
Status Date
TX
10/1/2010
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
EL PASO
2/5/2010
Practice City
SAN ANTONIO TX
1/17/2012
8/21/2009
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
License
Number
Physician Name
P2488
P1567
MASON, SHAUNNA TORRANCE,
MD
MASOOD, FARAH , MD
P2145
P4675
MASOODI, NASSEER A, MD
MASRUR, FATIMA, MD
dicaid
dicaid
Agreement
End Date
Designated)
3/15/2012
12/1/2011
2/10/2012
10/15/2012
OBSTETRICS AND
4/9/2010
ORTHOPEDIC
SURGERY OF THE
4/9/2015 SPINE
8/1/2013
P7503
MASSANET VOLLRATH, JOSE M.,
MD
MASSUMI, MAHSA ABOLFATHIAN,
MD
P2146
MASTERS, KEN , MD
N6921
P1197
P4887
MASTERSON, JESSICA , MD
MATADEEN-ALI, CHANDRA, MD
MATAOUI, NOHA, MD
7/1/2010
10/17/2011
11/15/2012
N8037
MATCHETT, GENOVEVE, MD
10/29/2010
N6483
MATCHETT, GERALD ALBERT, MD
6/4/2010
N0953
MATHAVAN, RAJEEV KUMAR, MD
MATHERS, RACHEL ELIZABETH,
MD
8/29/2008
12/1/2010
12/15/2010
P7669
P1568
MATHESON, THOMAS BLAIR, MD
MATHEW, MINI ANN, DO
MATHEW, NEETHU MUPPADHYIL,
MD
MATHEW, PAUL, MD
8/15/2013
12/1/2011
N8544
MATHEW, SALIM BENJAMIN, MD
INTERVENTIONAL
N5849
MATHEW, SANJAY JOHAN, MD
N5846
P7668
N8217
N8320
N4577
N6922
P3199
MATHEWS, REENA RACHEL, MD
MATHEWS, ZEEBA , MD
MATHUR, MONIKA, MD
2/10/2012
8/15/2013
1/18/2011
4/9/2010
11/6/2009
7/1/2010
5/15/2012
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
GERIATRICS INTERNAL MEDICINE
HOSPITALIST
ROCHESTER
NY
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ORTHOPEDIC
SURGERY
PLANO
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
7/1/2015 PALLIATIVE MEDICINE ONCOLOGY
10/17/2016 INTERNAL MEDICINE SLEEP MEDICINE
PEDIATRIC ANES
(PEDS)
DALLAS
GLEN MILLS
TX
PA
PAIN MANAGEMENT
INTERNAL MED - PREV
8/15/2018 MED
TEXAS CITY
Disciplinary
Status Date
3/15/2012 None
12/9/2011 None
N/A
N/A
2/10/2012 None
11/12/2012 None
N/A
N/A
4/27/2010 None
N/A
8/5/2013 None
N/A
2/10/2012 None
N/A
7/12/2010 None
10/21/2011 None
11/29/2012 None
N/A
N/A
N/A
10/29/2010 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
9/12/2008 None
N/A
TX
ACTIVE
8/21/2013 None
N/A
ND
TX
ACTIVE
ACTIVE
12/6/2010 None
12/28/2010 None
N/A
N/A
LAS CRUCES
NM
ACTIVE
ACTIVE
8/22/2013 None
12/6/2011 None
N/A
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
1/27/2011 None
N/A
4/9/2010 None
N/A
11/12/2009 None
7/14/2010 None
6/4/2012 None
N/A
N/A
N/A
GENERAL SURGERY BISMARCK
TEMPLE
CARDIOLOGY
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
4/9/2015 PSYCHIATRY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
FORT WORTH TX
TX
HOLDEN
MA
Page 170 of 300
ACTIVE
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N0956
MATISOFF, ANDREW JEFFREY, MD
8/29/2008
N7560
P3041
MATTIX, KELLY RYMAN, MD
MATUS, HEIDI L, MD
8/27/2010
5/1/2012
N7719
P1198
MAUD, ALBERTO, MD
MAVANI, GAURANG P, MD
MAVINKURVE, GAURAV GAJANAN,
MD
2/1/2013
ENDOVASCULAR
SURGICAL
9/15/2015 NEURORADIOLOGY
EMERGENCY
2/4/2016 MEDICINE
PEDIATRIC
EMERGENCY
8/1/2018 MEDICINE
GASTROENTEROLOG
2/1/2018 Y
MAYS, RANA MAJD, MD
MAYYA, SHARAT, MD
MAZHAR, DANISH, MD
7/15/2011
4/1/2011
4/9/2010
N3879
MBA, FARLEY ESIGFEI, MD
8/21/2009
P2492
N7637
MBADUGHA, IFEANYI M, MD
MCALHANEY, MAUREEN SIA, MD
3/15/2012
9/1/2010
P6030
MCBETH, KATRINA ELIZABETH, MD
P1896
MCCAIN, FRANCINE FRASER, MD
N7639
N9905
MCCAIN, KARWIN LAJUAN, MD
MCCALLUM, REX MONROE, MD
MCCANN-CROSBY, BONNIE MARIE,
MD
MCCLAIN, CHASE WAGNER, MD
MCCORMICK, SARAH
MARGUERITE, DO
N8685
P0634
N3878
MAY, MEGAN MICHELLE, MD
MAYHEW, AMY MARIE, MD
P7504
N9263
P5419
MAYOR, JOEY DAVID OSCAR, MD
MAYOR, REINA SARAH, MD
MAYORGA, CHRISTIAN ANTONIO
JR, MD
P0441
N9264
N5850
P1897
N5852
P7505
9/15/2010
10/17/2011
2/4/2011
8/1/2011
8/21/2009
8/1/2013
4/1/2011
4/1/2013
9/1/2010
6/3/2011
1/17/2012
4/9/2010
8/1/2013
Practice City
AUSTIN
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
9/9/2008 None
N/A
TX
TX
ACTIVE
ACTIVE
9/1/2010 None
5/3/2012 None
N/A
N/A
EL PASO
TX
ALEXANDRIA LA
CHATTANOOG
A
TN
ACTIVE
ACTIVE
9/20/2010 None
10/24/2011 None
N/A
N/A
ACTIVE
2/11/2011 None
N/A
SPORTS MEDICINE
(ORTH SURG)
HOUSTON
TX
8/12/2011 None
12/1/2009 None
N/A
N/A
PEDIATRICS
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
8/1/2013 None
4/13/2011 None
N/A
N/A
TX
ACTIVE
2/4/2013 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/20/2011 None
4/20/2011 None
4/14/2010 None
N/A
N/A
N/A
TX
ACTIVE
9/2/2009 None
N/A
TX
ACTIVE
ACTIVE
3/20/2012 None
9/20/2010 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
4/3/2013 None
N/A
1/17/2012 None
N/A
ACTIVE
ACTIVE
9/27/2010 None
6/15/2011 None
N/A
N/A
HOUSTON
VASCULAR
NEUROLOGY
451 N. TEXAS
DERMATOLOGY
AVE
HOSPITALIST
DALLAS
FAMILY MEDICINE
HUMBLE
EMERGENCY
MEDICINE
AMARILLO
CORPUS
PEDIATRICS
CHRISTI
PEDIATRIC
PULMONOLOGY
4/1/2018 PEDIATRICS
OBSTETRICS AND
PHYSICAL MED. &
1/17/2012
Secondary Specialty
(Self-Designated)
PEDIATRIC ANES
(PEDS)
Registration
Status of
Practice
Texas
State
License
HOUSTON
SAN ANTONIO TX
INTERNAL MEDICINE GALVESTON TX
8/1/2018 PEDIATRICS
Page 171 of 300
HOUSTON
LUBBOCK
TX
TX
ACTIVE
ACTIVE
1/23/2012 None
4/26/2010 None
N/A
N/A
TEMPLE
TX
ACTIVE
8/6/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
GYNECOLOGIC
GYNECOLOGIC
4/1/2013
4/1/2018 ONCOLOGY
SURGERY
P6032
MCCORMICK, TIMOTHY CHAD, DO
N5233
MCCRARY, JAMES EDWARD, DO
N8123
MCCREARY, REAGANN R, DO
N5854
MCCUAN, CLAYTON ALAN, DO
N7142
MCDONALD, DAVID WILLIAM, MD
7/15/2010
N9601
MCDONNOLD, MOLLIE ANN, MD
5/2/2011
P6033
N2647
MCDOWELL, AMANDA , MD
MCEWEN, DOUG RYAN, MD
4/1/2013
4/3/2009
N5856
MCFADDEN, MELISSA JEAN, DO
4/9/2010
P2731
MCGHIE, TRAVEA ALEE, MD
4/2/2012
P0094
MCGILL-VARGAS, LISA LYNN, MD
6/15/2011
L5833
10/1/2010
12/12/2008
N8124
MCGRORY, JAMES EDWARD, MD
MCGUCKIN, JAMES FREDERICK
JR, MD
MCILVAINE, WILLIAM BROWN JR,
MD
N8038
MCINTIRE, LISA UHL, MD
10/29/2010
N8220
MCKEE, DESIRAE , MD
P7506
N9265
MCKENZIE, KRISTI HAMILTON, MD
MCKEY, JOANNA LYNN, MD
N1760
2/5/2010
11/15/2010
4/9/2010
11/15/2010
12/1/2010
8/1/2013
4/1/2011
EMERGENCY
11/15/2015 MEDICINE
PEDIATRICS
DIAGNOSTIC
7/15/2015 RADIOLOGY
MATERNAL AND
CARDIOTHORACIC
INFECTIOUS
4/2/2017 DISEASES
OPHTHALMOLOGY 10/29/2015 ANTERIOR SURGERY
HAND SURGERY 12/1/2015 SURGERY
OBSTETRICS AND
8/1/2018 GYNECOLOGY
4/1/2016 PEDIATRICS
7/1/2010
7/1/2015 PEDIATRICS
N8420
MCKINNEY, MELISSA ANN, DO
1/3/2011
TX
HOSPITALIST
PEDIATRIC
RADIOLOGY
OBSTETRICS AND
GYNECOLOGY
HOUSTON
ABILENE
NEONATOLOGY
ORTHOPEDIC
SURGERY OF THE
SPINE
ORTHOPEDIC
10/1/2015 SURGERY
INTERVENTIONAL
MCKINNEY, JEFFREY SCOTT, MD
DALLAS
TX
TX
INTERNAL MEDICINE
N6925
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
PEDIATRIC ANES
(PEDS)
PLANO
EL PASO
GENERAL SURGERY LUBBOCK
AUSTIN
DALLAS
PEDIATRIC
INFECTIOUS
DISEASE
Page 172 of 300
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/1/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
12/10/2010 None
N/A
4/9/2010 None
N/A
7/15/2010 None
N/A
5/2/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/12/2013 None
4/9/2009 None
N/A
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/17/2012 None
N/A
6/15/2011 None
N/A
ACTIVE
10/11/2010 None
N/A
ACTIVE
4/28/2009 None
N/A
ACTIVE
LICENSE
ISSUED
12/2/2010 None
N/A
10/29/2010 None
N/A
TX
ACTIVE
1/11/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
8/2/2013 None
4/21/2011 None
N/A
N/A
7/1/2010 None
N/A
1/3/2011 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
J6583
P0997
N2650
P6463
P6678
N9908
P7159
N3882
P5291
N2653
N3883
N3176
N7840
N7143
Physician Name
MCKINNEY, WILLIAM BENJAMIN,
MD
dicaid
dicaid
Agreement
End Date
Designated)
4/9/2010
Registration
Status Date
Disciplinary
Status Date
FL
ACTIVE
4/21/2010 None
N/A
TX
ACTIVE
12/6/2011 None
N/A
NM
ACTIVE
4/9/2009 None
N/A
OK
TX
ACTIVE
ACTIVE
5/30/2013 None
5/17/2013 None
N/A
N/A
TX
ACTIVE
6/10/2011 None
N/A
TX
ACTIVE
7/15/2013 None
N/A
TX
ACTIVE
8/26/2009 None
N/A
LICENSE
ISSUED
1/15/2013 None
N/A
TX
ACTIVE
4/20/2009 None
N/A
8/21/2009
DALLAS
PAIN
MANAGEMENT/REHAB SPORTS MEDICINE 1/15/2018 MED
REHAB MED
GASTROENTEROLOG
4/3/2014 Y
SURGICAL CRITICAL
8/21/2014 CARE
HOUSTON
TX
ACTIVE
10/5/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
6/8/2009 None
N/A
10/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/20/2010 None
N/A
6/15/2011 None
N/A
9/15/2011
MCLAUGHLIN, MICHAEL PAUL, DO
MCLAURIN, LATISHA , MD
MCLEMORE, MICHAEL STEVEN,
MD
5/1/2013
5/15/2013
4/3/2009
6/3/2011
7/1/2013
8/21/2009
MCMILLEN, THURSTON DRU, MD
MCNEILL, CHRISTOPHER JOHN,
MD
MCNUTT, MICHELLE KATHLEEN,
MD
MCTAGUE, MATTHEW MARCUS,
DO
1/15/2013
5/29/2009
MCVAY, TRAVIS JAMES, MD
MCWILLIAMS, JEFFREY GRANT
SR, MD
10/1/2010
EMERGENCY
7/15/2015 MEDICINE
4/3/2009
7/15/2010
MEADOWS, MILTON WILLIAM, MD
6/15/2011
P7311
P6869
MEARS, SIMON CAVENDISH, MD
MEDINA, DIANA , MD
7/15/2013
6/3/2013
N7462
MEDLEY, DYLAN BLUE, MD
8/16/2010
ORTHOPEDIC
7/15/2018 SURGERY
EMERGENCY
8/16/2015 MEDICINE
N8322
MEDRANO-ENGLAND, KARLA , MD
MEGHAPARA, BHAVINKUMAR K,
MD
12/15/2010
1/15/2013
CONROE
LONGVIEW
TX
PEDIATRIC CRITICAL
CARE MEDICINE
P0095
P5292
Practice City
Disciplinary
Status of
Texas
License
GENERAL SURGERY LUTZ
PEDIATRIC
ANESTHESIOLOGY ANESTHESIOLOGY
(PEDS)
GALVESTON
ALBUQUERQU
4/3/2014 PEDIATRICS
HOSPITALIST
E
OKLAHOMA
ANESTHESIOLOGY
CITY
LUBBOCK
DERMATOPATHOLOG ANATOMIC
6/3/2016 Y
PATHOLOGY
HOUSTON
PHYSICAL MED. &
CORPUS
REHABILITATION
CHRISTI
MCKISSACK, MELANIE LENISE, MD
MCKNIGHT, HEATHER MICHELLE,
MD
MCLEOD, MICHAEL PAUL, MD
MCMILLAN, ADRIENNE MONICA,
MD
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
FAMILY MEDICINE
HOSPITALIST
Page 173 of 300
HOSUTON
TX
ACTIVE
ACTIVE
8/13/2013 None
6/27/2013 None
N/A
N/A
TEMPLE
TX
ACTIVE
8/26/2010 None
N/A
GALVESTON
TX
ACTIVE
2/4/2011 None
N/A
BAKERSFIELD CA
ACTIVE
1/22/2013 None
N/A
License
Number
Physician Name
P4786
MEHTA, AMIT MAYUR, MD
N8690
MEHTA, ANITA, MD
P0097
P5209
N9266
MEHTA, ANKUR D, DO
MEHTA, ARUN KUMAR
CHAMPAKLAL, MD
MEHTA, CHIRAG
VIRENDRAKUMAR, MD
MEHTA, JAIDEEP HEMU, MD
P7508
P4678
N4583
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
11/1/2012
11/1/2017 MEDICINE
2/4/2011
PHYSICAL MED. &
11/6/2009
1/4/2013
4/1/2011
MEHTA, MANISHA SHIVANG, DO
MEHTA, PANKAJ, MD
8/1/2013
10/15/2012
P0098
N1393
MEHTA, RAJUL RAJNIKANT, MD
MEHTA, SACHIN , MD
6/15/2011
10/10/2008
6/15/2016 BREAST IMAGING
N6927
MEJIA, JUAN CAMILO, MD
7/1/2010
P1106
MEKA, MADHAVI, MD
P4890
P6221
N7311
N9470
MEKETE, BAHIRU BELACHEW, MD
MELEK, JOHN, MD
MELENDEZ, JOSE A, MD
MELENDEZ, MARIA MERCEDES,
MD
MELETH, ANNAL DHANANJAYAN,
MD
P7160
N9909
MELLA, CESAR FRANCISCO, MD
MELLER, JANET LOUISE, MD
P6679
N0968
P7509
N8820
11/15/2012
4/12/2013
8/2/2010
2/15/2011
4/15/2011
Practice City
HOUSTON
TX
6/15/2011
10/3/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
PAIN
MANAGEMENT/REHA
B MED
NEPHROLOGY
ANESTHESIOLOGY
DIAGNOSTIC
RADIOLOGY
CARDIOLOGY
SOUTHGATE
MI
HOUSTON
TX
SPRINGFIELD MA
HOUSTON
10/3/2016 VASCULAR SURGERY GENERAL SURGERY BEDFORD
PHYSICAL MED. &
7/1/2013
6/3/2011
7/1/2018
6/3/2016
MELLOTT, JUSTIN, DO
MELMED, GAVIN MARK, MD
MELNITSKY, HANNAH , MD
5/15/2013
8/29/2008
8/1/2013
5/15/2018
8/29/2013
8/1/2018
P6222
MELTON, COLT LESLEY, MD
4/12/2013
4/12/2018
P5106
MELTON, JENNIFER LEIGH, MD
12/17/2012
12/17/2017
TX
TX
LAWTON
OK
SAN ANTONIO TX
PALLIATIVE
MEDICINE
OPHTHALMOLOGY
HOUSTON
PEDIATRIC CRITICAL
PEDIATRICS
CARE MEDICINE
HOUSTON
PEDIATRIC SURGERY
AMARILLO
FAMILY PRACTICE FAMILY PRACTICE
EMERGENCY MED
DIMMITT
ONCOLOGY
FAMILY MEDICINE
FORT WORTH
EMERGENCY
STEPHENVILL
MEDICINE
E
OPHTHALMOLOGY OPHTHALMOLOGY
CORNEA
GALVESTON
Page 174 of 300
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/27/2012 None
N/A
2/4/2011 None
N/A
ACTIVE
6/20/2011 None
N/A
ACTIVE
12/23/2009 None
N/A
2/14/2013 None
4/6/2011 None
N/A
N/A
8/1/2013 None
10/31/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/20/2011 None
12/9/2008 None
N/A
N/A
7/1/2010 None
N/A
ACTIVE
11/2/2011 None
N/A
11/20/2012 None
4/24/2013 None
8/10/2010 None
N/A
N/A
N/A
2/15/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
4/22/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
7/3/2013 None
6/16/2011 None
N/A
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
5/21/2013 None
9/5/2008 None
8/15/2013 None
N/A
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
4/22/2013 None
N/A
12/17/2012 None
N/A
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5106
12/17/2012
P5106
12/17/2012
N2656
MELTON, SHELBY DEAN, MD
4/3/2009
N7312
MEMON, NADA , MD
8/2/2010
P7671
MEMON, NAIM A, MD
8/15/2013
P6037
N5861
MEMON, REHAN, MD
MENARD, JAMES RYAN, MD
P0442
P6038
P7510
MENDEZ SOTO, DAVID B, MD
MENDEZ, ANGELICA DURAN, MD
MENDEZ, RUBEN , MD
P5842
4/1/2013
4/9/2010
7/15/2011
4/1/2013
8/1/2013
ANATOMIC/CLINICAL
4/3/2014 PATHOLOGY
ELECTROPHYSIOLOG
8/2/2015 Y
CARDIOLOGY
GERIATRIC
PSYCHIATRY
4/1/2018
8/1/2018 PSYCHIATRY
OBSTETRICS AND
INTERVENTIONAL
4/3/2014 CARDIOLOGY
3/15/2013
P1361
N9744
MENDEZ-FIGUEROA, HECTOR, MD
MENDEZ-MARTINEZ, JOSE
IGNACIO, MD
MENDEZ-RAMIREZ, JOSE MARIA,
MD
MENDIOLA, ANNA MARIE TEENA
CAPULONG, MD
MENDIOLA, LAURA LETICIA, MD
N5865
MENDLER, THOMAS MICHAEL, MD
4/9/2010
N1764
MENES, STEPHANIE IFEOMA, MD
12/12/2008
P6680
MENNITE, BRIDGIT, MD
5/15/2013
N4584
11/6/2009
P0443
MENON, ANIL SAMOILENKO, MD
MERCADO, CLAUDIA GETZABETH,
MD
EMERGENCY
5/15/2018 MEDICINE
EMERGENCY
11/6/2014 MEDICINE
7/15/2011
N7145
MERCADO, LEAH ALBANO, MD
7/15/2010
N2657
N7144
4/3/2009
Secondary Specialty
(Self-Designated)
MOLECULAR
GENETIC
PATHOLOGY
MATERNAL AND
FETAL MEDICINE
CARDIOVASCULAR
DISEASES
Practice City
GALVESTON
GALVESTON
Registration
Status of
Practice
Texas
State
License
LICENSE
TX
ISSUED
LICENSE
TX
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/17/2012 None
N/A
12/17/2012 None
N/A
ACTIVE
5/20/2009 None
N/A
HOUSTON
TX
ACTIVE
8/13/2010 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/16/2013 None
N/A
4/1/2013 None
4/26/2010 None
N/A
N/A
8/1/2011 None
4/4/2013 None
8/9/2013 None
N/A
N/A
N/A
TYLER
TX
CORAL
GABLES
FL
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
4/5/2013 None
N/A
EL PASO
TX
ACTIVE
4/16/2009 None
N/A
7/15/2010
EL PASO
TX
ACTIVE
7/26/2010 None
N/A
11/4/2011
5/16/2011
EL PASO
TX
ACTIVE
ACTIVE
11/11/2011 None
5/20/2011 None
N/A
N/A
HOUSTON
TX
ACTIVE
4/15/2010 None
N/A
MANSFIELD
TX
ACTIVE
2/23/2009 None
N/A
MIDDLETOWN CT
ACTIVE
5/21/2013 None
N/A
STANFORD
CA
ACTIVE
11/16/2009 None
N/A
LAREDO
TX
ACTIVE
LICENSE
ISSUED
7/21/2011 None
N/A
7/15/2010 None
N/A
Page 175 of 300
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N8221
MERCADO, THOMAS MICHAEL, MD
N5244
P6464
MEREDITH, SARAH JOANNE, DO
MERRITT, NATHAN HENRY, MD
H1395
N4585
MERWIN, JOHN DAVID II, MD
MESARWI, OMAR , MD
7/1/2010
11/6/2009
N9745
MESFIN, FASSIL B, MD
5/16/2011
NEUROLOGICAL
5/16/2016 SURGERY
P2732
MESHRAM, SHEETAL , MD
MESSER, JAMIE CHRISTOPHER,
MD
4/2/2012
8/30/2013
N1767
P5685
N8324
MESSICK, CRAIG ALAN, MD
MESSIER, CHRISTOPHER BRIAN,
MD
MESSING, ROBERT OWEN, MD
METWALLI, ZEYAD AHMED, MD
P1362
METZ, RACHEL LYNN, MD
N2660
P0855
METZGER, BRIAN SCOTT , MD
MEYER, ANDREW DUNCAN
JOSEPH, MD
H4840
MEYER, BRUCE ALAN, MD
H9239
N8041
MEYER, YVES JEAN, MD
MICHAEL, ADRIAN A, MD
P6467
MICHAEL, WAYNE ALAN, MD
5/1/2013
P7512
MICHAUD, ROBERT JEROME, MD
8/1/2013
MATERNAL AND
NEUROLOGICAL
5/15/2018 SURGERY
ORAL &
MAXILLOFACIAL
5/1/2018 SURGERY
EMERGENCY
8/1/2018 MEDICINE
N4587
MICHEL, YENNI LILLIA, DO
11/6/2009
N9267
P7811
12/1/2010
2/5/2010
5/1/2013
4/1/2011
12/12/2008
3/1/2013
12/15/2010
11/4/2011
4/3/2009
8/26/2011
6/4/2010
5/15/2013
10/29/2010
FAMILY
4/1/2016 UROLOGY
DIAGNOSTIC
3/1/2018 NEUROLOGY
EMERGENCY
11/4/2016 MEDICINE
INFECTIOUS
4/3/2014 DISEASES
PEDIATRIC CRITICAL
Secondary Specialty
(Self-Designated)
PAIN MANAGEMENT
Practice City
Registration
Status of
Practice
Texas
State
License
AMARILLO
TX
SOUTHLAKE
TX
ST. LOUIS
MO
HOUSTON
TX
UROLOGIC
ONCOLOGY
COLON AND RECTAL
SURGERY
URGENT CARE
MEDICINE
ACTIVE
LICENSE
ISSUED
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
12/8/2010 None
N/A
2/5/2010 None
5/6/2013 None
N/A
N/A
7/1/2010 None
1/6/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
5/24/2011 None
N/A
4/2/2012 None
N/A
4/1/2011 None
N/A
8/30/2013 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
12/29/2008 None
3/14/2013 None
1/3/2011 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
11/10/2011 None
N/A
TX
ACTIVE
4/9/2009 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
9/7/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
5/16/2013 None
11/4/2010 None
N/A
N/A
TX
ACTIVE
5/8/2013 None
N/A
SAN ANTONIO TX
ACTIVE
DEL VALLE
ACTIVE
PEDIATRICS
SAN ANTONIO TX
OBSTETRICS AND
GYNECOLOGY
KANSAS CITY MO
FORT WORTH TX
TX
DALLAS
FAMILY
PRACTICE/OMM
Page 176 of 300
Disciplinary
Status Date
DALLAS
AUSTIN
HOUSTON
FAMILY MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
8/6/2013 None
SEE
PREVIOUS
12/3/2009 ORDER
N/A
8/24/2009
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1672
MIDGLEY, PHILIP GLENN, DO
P2301
P5686
N3888
MIER Y TERAN, JOSE LUIS, MD
MIHU, RAMONA , MD
MIKESKA, HEATHER ANN, MD
3/1/2012
3/1/2013
8/21/2009
P4594
P7312
MIKHAIL, PETER, MD
MILAN, STACEY ANNE, MD
10/1/2012
7/15/2013
CARDIOVASCULAR
10/1/2017 SURGERY
N6493
P5557
P5422
MILLAN, LIZ PAULINA, MD
MILLENDER, KAREN LOUISE, MD
MILLER, ADAM RICHARD, MD
6/4/2010
2/8/2013
2/1/2013
OBSTETRICS AND
6/4/2015 GYNECOLOGY
N8042
N3891
N2662
MILLER, BRADLEY BRYAN, MD
MILLER, DENNIS WARREN, MD
MILLER, DILLON DERRICK, MD
10/29/2010
8/21/2009
4/3/2009
N7146
N4588
MILLER, GREGG AARON, MD
MILLER, JEREMY SCOTT , MD
7/15/2010
11/6/2009
P0444
MILLER, JOSHUA PAUL SR, MD
7/15/2011
N9388
MILLER, KEEGAN VERN, DO
N4589
MILLER, QUINTESSA, MD
11/6/2009
N7563
MILLER, RHEE WADE, MD
8/27/2010
P4983
MILLER, RYAN BRYCE, MD
11/30/2012
P5423
H3915
P7513
MILLER, TYRONE JOSEPH, DO
MILLER, WILFRED DEAN, DO
MILLIN, JOHN ANDREW, MD
TM00529 MILLMOND, STEVEN HARRIS, MD
P4893
MILLS, ALICIA E, MD
12/15/2011
4/8/2011
2/1/2013
7/15/2011
8/1/2013
11/1/2012
11/15/2012
Secondary Specialty
(Self-Designated)
FAMILY MEDICINE
EMERGENCY
7/15/2015 MEDICINE
11/6/2014 PATHOLOGY
EMERGENCY
7/15/2016 MEDICINE
EMERGENCY
4/8/2016 MEDICINE
PLASTIC &
RECONSTRUCTIVE
11/6/2014 SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
FORT WORTH TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
TX
TX
ACTIVE
ACTIVE
TX
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LOS ANGELES CA
AUGUSTA
GA
FORT SAM
HOUSTON
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
UNDER
BOARD
12/19/2011 ORDER
12/1/2011
3/1/2012 None
3/8/2013 None
8/28/2009 None
N/A
N/A
N/A
10/3/2012 None
7/25/2013 None
N/A
N/A
6/4/2010 None
2/12/2013 None
2/5/2013 None
N/A
N/A
N/A
10/29/2010 None
9/9/2009 None
5/5/2009 None
N/A
N/A
N/A
ACTIVE
ACTIVE
7/26/2010 None
11/17/2009 None
N/A
N/A
ACTIVE
7/20/2011 None
N/A
FORT WORTH TX
ACTIVE
4/19/2011 None
N/A
ACTIVE
11/16/2009 None
N/A
ANESTHESIOLOGY
ACTIVE
LICENSE
ISSUED
9/10/2010 None
N/A
11/30/2012 None
N/A
LA GRANGE
WICHITA
THORACIC SURGERY FALLS
EL PASO
OBSTETRICS &
GYNECOLOGICAL
SURGERY
LABORATORY
MEDICINE
EL PASO
UVALDE
SAHUARITA
LAS CRUCES
DIAGNOSTIC
11/1/2017 RADIOLOGY
NUCLEAR MEDICINE LYNDHURST
MANSFIELD
Page 177 of 300
AZ
NM
ACTIVE
ACTIVE
ACTIVE
2/22/2013 None
7/21/2011 None
8/7/2013 None
N/A
N/A
N/A
OH
TX
ACTIVE
ACTIVE
11/6/2012 None
11/26/2012 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P0639
MILNER, JENNIFER NICOLE, MD
8/1/2011
P5687
MILOV, SEVA, MD
3/1/2013
N9268
N0981
MILOV, SIMON, MD
MINA, EMAN GAMIL-FAHIM, MD
N5246
MINER, GEORGE R. IV, MD
4/1/2011
8/29/2008
2/5/2010
8/1/2016 PEDIATRICS
OBSTETRICS AND
3/1/2018 GYNECOLOGY
OTORHINOLARYNGOL HEAD AND NECK
4/1/2016 OGY
SURGERY
MININA, IRINA ANATOLIYEVNA, MD
MINN, CHARLES KEE JOON, MD
8/29/2008
8/1/2013
N8423
MINSHALL, CHRISTIAN TODD, MD
1/3/2011
P5109
MIOCINOVIC, SVJETLANA, MD
12/17/2012
P5109
12/17/2012
P5109
12/17/2012
N5872
P4484
MIR, MOHSIN REHMAN, MD
MIR, TASADUQ HUSSAIN, MD
4/9/2010
9/17/2012
N9748
MIRANDA, JENNIFER JOANNE, MD
5/16/2011
ENDOCRINOLOGY,
DIABETES AND
N0985
MIRANDA, LEONIDAS SANTOS, MD
8/29/2008
N5247
MIRANDA, MARY ANN VENITA, MD
2/5/2010
PHYSICAL MED. &
MIRASOL, ALAN P, MD
11/15/2011
N9604
MIRCHANDANI, AMIT, MD
5/2/2011
P0640
MIRELES, PATRICIA SALAZAR, MD
8/1/2011
N5248
MIRMOW, DWIGHT PAUL, MD
2/5/2010
P4595
MIROSHNICHENKO, GENNADY, MD
10/1/2012
Practice City
EHT
NJ
HARLINGEN
TX
SAN ANTONIO TX
N0982
P7514
P1476
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
PEDIATRIC
8/1/2016 NEUROLOGY
NEPHROLOGY
CRITICAL CARE
(SURGERY)
MOVEMENT
DISORDERS
MOVEMENT
DISORDERS
MOVEMENT
DISORDERS
DERMATOLOGIC
SURGERY
N/A
3/12/2013 None
N/A
4/6/2011 None
9/8/2008 None
N/A
N/A
2/5/2010 None
N/A
9/10/2008 None
8/16/2013 None
N/A
N/A
DALLAS
TX
ACTIVE
1/17/2011 None
N/A
DALLAS
TX
ACTIVE
12/24/2012 None
N/A
DALLAS
TX
ACTIVE
12/24/2012 None
N/A
DALLAS
TX
ACTIVE
12/24/2012 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
4/14/2010 None
10/1/2012 None
N/A
N/A
EAST
PROVIDENCE RI
ACTIVE
5/30/2011 None
N/A
9/8/2008 None
N/A
2/5/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
BEVERLY
HILLS
CA
ACTIVE
11/17/2011 None
N/A
DALLAS
TX
ACTIVE
5/10/2011 None
N/A
PLANO
TX
ACTIVE
LICENSE
ISSUED
8/5/2011 None
N/A
2/5/2010 None
N/A
10/4/2012 None
N/A
FORT WORTH TX
Page 178 of 300
8/1/2011 None
ACTIVE
ACTIVE
HOSPITALIST
2/5/2015 PATHOLOGY
GYNECOLOGIC
10/1/2017 ONCOLOGY
ACTIVE
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
BROWNSVILL
E
TX
HOUSTON
TX
HOUSTON
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
N7464
MIRPURI, JULIE, MD
8/16/2010
N6930
P4596
N0986
MIRYALA, REKHA, MD
MIRYALA, SHYAMALA, MD
MIRZA, ABSAR A, MD
7/1/2010
10/1/2012
8/29/2008
N9910
MIRZA, KHURRAM REHMAN, MD
6/3/2011
N6495
MIRZA, MUHAMMAD AZIM , MD
6/4/2010
N6496
MIRZA, RIZVAN ALLEN, MD
6/4/2010
N8325
MIRZA, RUBINA ASIF, MD
P2735
MIRZA, UMARFAROOK JAVED, DO
4/2/2012
N3897
MISHRA, CHANDER SHEKHAR, MD
MISHRA, MICHAEL DONALD VIJAY,
MD
8/21/2009
P2303
P5843
12/15/2010
3/1/2012
3/15/2013
N5250
MISRA, NEETI V, MD
MISSELBECK, TIMOTHY SCOTT,
MD
N6497
N8424
MISSIOS, SYMEON, MD
MITCHELL, ANGELA HEAPE, MD
6/4/2010
1/3/2011
P1108
MITCHELL, BAKER ADAMS III, MD
MITCHELL, IAN CRICHTON SLIGHT,
MD
10/3/2011
10/1/2010
N7948
MITCHELL, KRISTINA OREY, MD
MITRA, RANJANA NEELANJANA,
MD
P5425
MITRO, JOSEPH CALEB, MD
2/1/2013
N6498
MITTAL, RICHA, MD
6/4/2010
P3391
N7843
2/5/2010
6/1/2012
10/15/2010
Practice City
ATLANTA
INTERNAL MEDICINE GREENVILLE
HEMATOLOGY/ONCOL
6/4/2015 OGY
INTERNAL MEDICINE
DIAGNOSTIC
6/4/2015 RADIOLOGY
INTERVENTIONAL
CARDIOLOGY
EMERGENCY
4/2/2017 MEDICINE
BRONX
CARDIOTHORACIC
ANESTHESIOLOGY
ARLINGTON
3/1/2017 RADIOLOGY
OBSTETRICS AND
CARDIOVASCULAR
2/5/2015 SURGERY
NEUROLOGICAL
6/4/2015 SURGERY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status of
Practice
Texas
State
License
GA
TX
SC
N/A
7/1/2010 None
11/20/2012 None
11/17/2008 None
N/A
N/A
N/A
6/3/2011 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
12/15/2010 None
N/A
4/3/2012 None
N/A
TX
ACTIVE
8/28/2009 None
N/A
PLANO
TX
ACTIVE
3/12/2012 None
N/A
FREEHOLD
NJ
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/21/2013 None
N/A
2/5/2010 None
N/A
6/4/2010 None
1/7/2011 None
N/A
N/A
10/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
6/5/2012 None
N/A
10/1/2010 None
N/A
10/15/2010 None
N/A
2/1/2013 None
N/A
6/4/2010 None
N/A
HOSPITALIST
Page 179 of 300
8/18/2010 None
ACTIVE
GENERAL SURGERY
HOSPITALIST
Disciplinary
Status Date
NY
6/1/2017 PEDIATRIC SURGERY GENERAL SURGERY SAN ANTONIO TX
OBSTETRICS AND
2/1/2018 GYNECOLOGY
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
AUSTIN
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
ENDOCRINOLOGY,
DIABETES AND
COLLEGE
1/17/2012
INTERNAL MEDICINE STATION
P1901
MITTAN, DANIELLA MARIANA, MD
N7147
MIWA, EDWARD ALEJANDRO, MD
P7673
N1776
MIYAKE, CHRISTINA, MD
MOADDELI, NEDA , MD
N5873
MOAMMAR, OUSAMA, MD
P6682
MOBAYED, MOHAMMAD, MD
5/15/2013
N9912
MODI, APURVA ASHOK, MD
6/3/2011
N9098
MODI, CHIRAG H, MD
3/15/2011
P4485
MODI, HRISHIKESH , MD
9/17/2012
N0991
MODI, PRACHI MAHENDRA, MD
8/29/2008
N8692
3/15/2011
N5875
MOEN, TODD CHRISTOPHER, MD
MOGABGAB, OWEN NORTHROP,
MD
MOHAMED, MAHMOUD
ABDELMONEM, MD
N8225
MOHAMMAD, AMAL OTHMAN, MD
12/1/2010
N1778
MOHAMMAD, FAWZI TAWFIC, MD
12/12/2008
N9099
P7674
MOHAMMED, ANWARULLAH , MD
N7313
P4788
MOHAMMED, HUMERA , MD
MOHAN, KRISHN , MD
N8956
MOHAN, PRADEEP SHARMA, MD
7/15/2010
8/15/2013
12/12/2008
4/9/2010
2/4/2011
4/9/2010
8/15/2013
8/2/2010
11/1/2012
3/1/2011
PEDIATRICS,
FAMILY PRACTICE
ELECTROPHYSIOLO
GY
HOUSTON
CHICAGO
HEMATOLOGY/ONCOL
5/15/2018 OGY
INTERNAL MEDICINE FINDLEY
GASTROENTEROLOG
6/3/2016 HEPATOLOGY
Y
GERIATRIC
MEDICINE (INTERNAL
MED)
URGENT CARE
MEDICINE
HOUSTON
EMERGENCY
8/29/2013 MEDICINE
AUSTIN
ORTHOPEDIC
2/4/2016 SURGERY
OTHER SPECIALTY
Registration
Status of
Practice
Texas
State
License
TX
1/19/2012 None
N/A
7/15/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/23/2013 None
1/14/2009 None
N/A
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
5/17/2013 None
N/A
6/3/2011 None
N/A
LICENSE
ISSUED
3/15/2011 None
N/A
TX
ACTIVE
9/21/2012 None
N/A
TX
ACTIVE
9/9/2008 None
N/A
ACTIVE
2/14/2011 None
N/A
ACTIVE
LICENSE
ISSUED
3/29/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
12/6/2010 None
N/A
ACTIVE
1/1/2009 None
N/A
ACTIVE
8/16/2013 None
N/A
ACTIVE
ACTIVE
8/12/2010 None
11/15/2012 None
N/A
N/A
ACTIVE
3/7/2011 None
N/A
TX
IL
OH
TX
DIAGNOSTIC
OBSTETRICS AND
8/2/2015 GYNECOLOGY
PLASTIC &
RECONSTRUCTIVE
3/1/2016 SURGERY
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 180 of 300
ABILENE
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
4/9/2015
WICHITA
FALLS
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6871
MOISI, MARC DANIEL, MD
6/3/2013
6/3/2018 FLEXIBLE
P5427
MOIZ, ABDUL, MD
2/1/2013
2/1/2018 NEPHROLOGY
P6042
MOJTAHEDI, ALIREZA, MD
4/1/2013
P5110
MOKHASHI, MOINUDDIN HABIB, MD
12/17/2012
P5110
12/17/2012
P5110
N2197
12/17/2012
2/6/2009
3/1/2012
N7844
MOKWE, EVAN O, MD
MOLINA ROJO, JOANNA ESTHER,
MD
MOLLEDA CASTRO, IMGARD
CAROLINA, MD
PEDIATRIC
PEDIATRIC
PEDIATRIC
N6501
MOMENI, MAZDAK , MD
P3651
N9749
P0767
MONAGHAN, MICAH, MD
MONAGHAN, SARA ANTOINETTE,
MD
MONFORD, DIANE KAY, MD
P6469
MONGE, MARIA CLAIRE, MD
P4486
MONGKOLRATTANOTHAI,
KANOKPORN, MD
P2305
N9389
P0445
MONROY, ANWAR EDUARDO, MD
MONTANA DE LA CADENA, PAULA
ANDREA, MD
TM00348 MONTES, ARTHUR ANDREW, MD
P4985
N0994
MONTES, JORGE ANTONIO, MD
MONTGOMERY, ELIZABETH GAIL,
MD
10/1/2010
6/4/2010
6/15/2012
5/16/2011
8/15/2011
5/1/2013
9/17/2012
4/8/2011
7/15/2011
4/9/2010
11/30/2012
8/29/2008
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
CARDIOLOGY
OBSTETRICS AND
6/4/2015 GYNECOLOGY
RADIATION
6/15/2017 ONCOLOGY
HEMATOLOGY
(PATHOLOGY)
CYTOPATHOLOGY
INTERNAL MED PEDS
5/16/2016 PATHOLOGY
8/15/2016 PATHOLOGY
ADOLESCENT
5/1/2018 MEDICINE - IM
CORPUS
CHRISTI
CORPUS
CHRISTI
UVALDE
OPHTHALMOLOGY
Page 181 of 300
2/1/2013 None
N/A
4/1/2013 None
N/A
12/17/2012 None
N/A
TX
ACTIVE
2/6/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
2/6/2013 None
3/2/2009 None
N/A
N/A
ACTIVE
3/13/2012 None
N/A
ACTIVE
LICENSE
ISSUED
10/5/2010 None
N/A
6/4/2010 None
N/A
PORT
ARTHUR, TX
TX
ACTIVE
6/18/2012 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
5/20/2011 None
8/22/2011 None
N/A
N/A
BOSTON
MA
ACTIVE
6/4/2013 None
N/A
TX
ACTIVE
10/9/2012 None
N/A
4/8/2011 None
N/A
PEDIATRIC
LUBBOCK
GERIATRIC
MEDICINE (INTERNAL
MED)
DIAGNOSTIC
4/9/2015 RADIOLOGY
OPHTHALMOLOGY 11/30/2017 ANTERIOR SURGERY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
6/6/2013 ORDER
5/15/2013
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
7/21/2011 None
N/A
LAS VEGAS
NV
ACTIVE
4/29/2010 None
N/A
SAN ANTONIO TX
ACTIVE
12/17/2012 None
N/A
ACTIVE
1/21/2009 None
N/A
License
Number
N7950
N1782
N7149
N5879
Physician Name
MONTILLA, RICHARD VINCENT
DELEON, MD
MONTOYA, ALBERTO EDUARDO,
MD
MONTOYA, MELISSA MARINA, MD
MONTOYA, TEODORO IGNACIO,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PLASTIC &
RECONSTRUCTIVE
HAND SURGERY 10/15/2010
10/15/2015 SURGERY
PLASTIC SURGERY
EMERGENCY
12/12/2008
12/12/2013 MEDICINE
FAMILY MEDICINE
7/15/2010
4/9/2010
N2198
MOOLA, SUNITA , MD
2/6/2009
N8693
MOOLAMALLA, SURJIT REDDY, MD
2/4/2011
P5690
P2306
N5882
MOON, MIA KWUN, MD
MOON, TIFFANY SUN, MD
MOONAT, JOOHEE , MD
3/1/2013
3/1/2012
4/9/2010
N5259
MOORE, ALTON E. II, DO
2/5/2010
P2307
MOORE, DAVID FRANCIS, MD
3/1/2012
P2147
MOORE, GRADIE ELIZABETH, MD
P2039
MOORE, JULENE RAE, MD
P0100
MOORE, KENNETH PAGE, MD
N6504
MOORE, LEE DAVID, MD
2/10/2012
2/1/2012
6/15/2011
6/4/2010
N9607
MOORE, MELITA NACHETTE', MD
5/2/2011
P5691
MOORE, MILTON RAHMON, MD
3/1/2013
P1365
MOORE, NAKITA M, MD
11/4/2011
OBSTETRICS AND
4/9/2015 GYNECOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
2/6/2014 GYNECOLOGY
OBSTETRICS &
GYNECOLOGICAL
2/4/2016 SURGERY
FAMILY
3/1/2017 NEUROLOGY
OBSTETRICS AND
ANATOMIC/CLINICAL
2/1/2017 PATHOLOGY
PHARMACEUTICAL
MEDICINE
HOSPITALIST
VASCULAR
NEUROLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ITHACA
NY
PEDIATRIC
Disciplinary
Status Date
10/15/2010 None
N/A
ACTIVE
2/12/2009 None
N/A
ACTIVE
7/19/2010 None
N/A
EL PASO
TX
ACTIVE
4/27/2010 None
N/A
LAS CRUCES
NM
ACTIVE
3/16/2009 None
N/A
2/4/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
3/4/2013 None
3/6/2012 None
4/26/2010 None
N/A
N/A
N/A
2/5/2010 None
N/A
ACTIVE
3/28/2012 None
N/A
ACTIVE
2/14/2012 None
N/A
LICENSE
ISSUED
FORT WORTH TX
DALLAS
TX
DALLAS
RATON
TX
NM
OBSTETRICS &
GYNECOLOGICAL
6/4/2015 SURGERY
PHYSICAL MED. &
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
2/6/2012 None
N/A
6/15/2011 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
ACTIVE
6/1/2011 None
N/A
& REHABILITATION
URGENT CARE
MEDICINE
HOUSTON
TX
ACTIVE
3/26/2013 None
N/A
PSYCHIATRY
TX
ACTIVE
11/29/2011 None
N/A
Page 182 of 300
TEMPLE
License
Number
Physician Name
N8426
N8427
MOORE, ROBERT KEITH JR, MD
MOORE, VICKI PHILLIPS, DO
N6507
MOOSA, AZEEMA, MD
P4487
N6933
MOOSA, YUNUS, MD
MOPARTY, DEEPA REDDY, MD
P1477
MORALES MENDEZ, JACOBO S,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
1/3/2011
1/3/2016 MEDICINE
1/3/2011
1/3/2016 PEDIATRICS
OBSTETRICS AND
6/4/2010
6/4/2015 GYNECOLOGY
OBSTETRICS
INTERVENTIONAL
CARDIOVASCULAR
9/17/2012
DISEASES
7/1/2010
11/15/2011
N8958
MORALES, ADAM FERNANDO, MD
3/1/2011
N5884
MORALES, AL P, MD
4/9/2010
P0446
MORALES, FRANCISCO J, MD
7/15/2011
N5885
MORALES, MARLENE ELENA, MD
N9390
N9750
P4894
MORALES, ROLANDO JR, MD
MORAN, JENNIFER DAWN, MD
MORANI, AJAYKUMAR
CHANDRALAL, MD
P7675
N2672
N3906
MORCOS, HANAN, MD
MORE, ELIZABETH VON, MD
MOREIRA, ALVARO G., MD
8/15/2013
4/3/2009
8/21/2009
N9471
MOREL, JOSE BETHOVEN, MD
4/15/2011
4/9/2010
4/8/2011
5/16/2011
11/15/2012
N6508
N2673
MORENO, ARMIDA GALAVIZ, MD
MORENO, MIGUEL ANDRES, MD
6/4/2010
4/3/2009
N5888
MORGAN, JESSICA ANNE, MD
4/9/2010
Practice City
CORPUS
CHRISTI
DALLAS
ZACHARY
Registration
Status of
Practice
Texas
State
License
TX
TX
LA
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
3/1/2016 RADIOLOGY
DIAGNOSTIC
7/15/2016 RADIOLOGY
INTERVENTIONAL
RADIOLOGY
PLASTIC &
RECONSTRUCTIVE
4/8/2016 SURGERY
ABDOMINAL
CARDIAC
ELECTROPHYSIOLOG
8/15/2018 Y
OBSTETRICS &
GYNECOLOGICAL
6/4/2015 SURGERY
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
1/7/2011 None
1/13/2011 None
N/A
N/A
6/4/2010 None
N/A
9/21/2012 None
7/16/2010 None
SEE
PREVIOUS
11/15/2011 ORDER
N/A
N/A
7/5/2011
3/7/2011 None
N/A
4/9/2010 None
N/A
LAREDO
TX
ACTIVE
7/22/2011 None
N/A
OPHTHALMOLOGY RECONST SURGERY DALLAS
TX
ACTIVE
4/21/2010 None
N/A
GALVESTON
TEMPLE
TX
TX
ACTIVE
ACTIVE
4/15/2011 None
5/20/2011 None
N/A
N/A
HOUSTON
TX
ACTIVE
12/3/2012 None
N/A
SAN ANGELO
KYLE
GALVSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
8/19/2013 None
4/30/2009 None
9/18/2009 None
N/A
N/A
N/A
4/15/2011 None
N/A
6/4/2010 None
4/14/2009 None
N/A
N/A
4/9/2010 None
N/A
PEDIATRIC
RADIOLOGY
CARDIOVASCULAR
DISEASES
NEONATOLOGY
OBSTETRICS AND
GYNECOLOGY
4/9/2015 PEDIATRICS
Page 183 of 300
EL PASO
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
H3122
P7816
MORGAN, PETER BRIAN, MD
MORGAN, RUTH, MD
8/21/2009
8/30/2013
P1366
MORGAN, SHERRI LYNN, MD
11/4/2011
P0641
P1790
MORGAN, TIMOTHY GENE, DO
MORILLA HOLGUIN, MIGUEL
EMILIO, MD
J9225
MORO-SUTHERLAND, DONNA
MARIE, MD
DIAGNOSTIC
8/1/2016 RADIOLOGY
INFECTIOUS
1/2/2017 DISEASES
PEDIATRIC
EMERGENCY
N3192
P4488
MORRIS, BERNARD DAVID JR, MD
MORRIS, EVELYN LETHITIA, MD
N5263
MORRIS, JUSTIN P, DO
N3909
N1504
MORRIS, SUSAN HENDERSON , MD
MORRIS, TRICIA JUDITH, MD
N3910
MORRISON, CHRISTOPHER
ANDREW, MD
P6874
MORRISON, ROBERT STANLEY III,
MD
8/1/2011
1/2/2012
8/1/2011
5/29/2009
9/17/2012
2/5/2010
8/21/2009
12/12/2008
8/21/2009
5/29/2014 UROLOGY
EMERGENCY
2/5/2015 MEDICINE
PEDIATRIC CRITICAL
6/3/2013
DIAGNOSTIC
6/3/2018 RADIOLOGY
6/4/2010
EMERGENCY
6/4/2015 MEDICINE
N5264
MORRISSEY, RYAN PATRICK, MD
MORRISSEY, WILLIAM JOSEPH JR,
MD
2/5/2010
2/5/2015 PEDIATRICS
N9916
MORROW, JASON, MD
6/3/2011
J9528
12/12/2008
P1368
MORSCH, JAMES KYLE, MD
MOSCOSO AGOSTO, ALEJANDRA,
MD
P2500
MOSCOSO, WALTER ENRIQUE, MD
3/15/2012
N6510
11/4/2011
Secondary Specialty
(Self-Designated)
VASCULAR
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
BEAUMONT
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
10/22/2009 None
9/2/2013 None
N/A
N/A
OBSTETRICS AND
GYNECOLOGY
DALLAS
TX
ACTIVE
11/28/2011 None
N/A
NEURO-RADIOLOGY
DALLAS
TX
ACTIVE
8/5/2011 None
N/A
PALMVIEW
TX
ACTIVE
1/9/2012 None
N/A
PEDIATRICS
HOUSTON
TX
ACTIVE
8/8/2011 None
N/A
GERIATRICS
KILLEEN
WORCESTER
TX
MA
ACTIVE
ACTIVE
LICENSE
ISSUED
7/28/2009 None
10/11/2012 None
N/A
N/A
2/5/2010 None
N/A
FAMILY PRACTICE
UNDERSEA AND
HYPERBARIC MED
(PREV MED)
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
MEDICAL
TOXICOLOGY
(EMERGENCY
MEDICINE)
PEDIATRIC EMER
MED (PEDS)
PALLIATIVE
MEDICINE
Page 184 of 300
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
9/1/2009 None
1/28/2009 None
N/A
N/A
TIERRA
VERDE
FL
ACTIVE
9/11/2009 None
N/A
BEAUMONT
TX
ACTIVE
6/6/2013 None
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
SAN ANTONIO TX
COPPERAS
COVE
TX
ACTIVE
6/14/2011 None
N/A
ACTIVE
2/4/2009 None
N/A
DALLAS
CORPUS
CHRISTI
TX
ACTIVE
11/7/2011 None
N/A
TX
ACTIVE
3/19/2012 None
N/A
License
Number
P1791
Physician Name
MOSER, DAVID WALTER, DO
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRIC
1/2/2012
1/4/2012 None
N/A
DALLAS
TX
ACTIVE
4/8/2013 None
N/A
HOUSTON
TX
ACTIVE
5/21/2012 None
N/A
ACTIVE
2/8/2010 None
N/A
P3208
MOSS, HART BEAMAN, MD
5/15/2012
N4602
MOSSABEB, ROSCHANAK, MD
11/6/2009
N9101
MOSTAFA, KAMEL, MD
3/15/2011
P0256
MOSU, NICOLAE, MD
P1111
MOTAMARRY, SILUS, MD
10/3/2011
NEONATAL3/15/2016 PERINATAL MEDICINE NEONATOLOGY
OBSTETRICS AND
7/1/2016 GYNECOLOGY
OPHTHALMOLOGY 10/3/2016 RECONST SURGERY UNSPECIFIED
D8040
10/3/2011
N5891
MOTES, JOSEPH L JR, MD
MOTOLENICH, PETER MICHAEL
JR, MD
4/9/2010
P2309
MOTTL, STEVEN DAVID JR, DO
3/1/2012
N5265
N1000
MOULIN, VICTOR GREGOIRE, MD
MOURAD, SHADI MICHEL, MD
N9391
MOUSTAFA, MOUSTAFA H, MD
3/1/2017 CARDIOLOGY
CRITICAL CARE
EMERGENCY
4/8/2016 MEDICINE
N8822
P5212
MOUZI, LISA KRISTINE, MD
MOVVA, SUDHIR BABU, MD
MOWER, MARK WILLIAM, MD
MUEHE, NATALI MATTERN, MD
MUEHLENBEIN, STEPHEN JOSEPH,
TM00393 MD
4/8/2011
2/15/2011
1/4/2013
9/1/2010
3/15/2011
10/1/2010
EMERGENCY
9/1/2015 MEDICINE
DIAGNOSTIC
10/1/2015 RADIOLOGY
K0143
MUENS, GUENTHER, MD
3/15/2013
P0449
MUGHAL, MOHAMMAD ANSAR, MD
7/15/2011
P1112
MUGHRABI, LINDA BASSAM, MD
10/3/2011
OBSTETRICS AND
Disciplinary
Status Date
ACTIVE
2/5/2010
8/29/2008
Registration
Status Date
TX
MOSES, ELI, MD
7/1/2011
Practice City
Disciplinary
Status of
Texas
License
AUSTIN
P6044
N7642
N9102
4/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
WORCESTER
MA
ACTIVE
4/4/2011 None
N/A
JAMAICA
NY
ACTIVE
7/25/2011 None
N/A
SAN ANTONIO TX
ACTIVE
10/5/2011 None
UNDER
BOARD
10/9/2011 ORDER
N/A
GENERAL SURGERY
ACTIVE
YOUNGSTOW
N
OH
CARDIOVASCULAR
IMAGING
LEWISVILLE
ANESTHESIOLOGY
INTERNAL MEDICINE EAGLE PASS
NEPHROLOGY
URGENT CARE
MEDICINE
Page 185 of 300
TX
TX
ACTIVE
9/14/2011
5/3/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
3/12/2012 None
N/A
2/5/2010 None
9/18/2008 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/18/2011 None
N/A
2/15/2011 None
1/9/2013 None
N/A
N/A
AMARILLO
TX
RUTLAND
VT
TEMPLE
TX
ACTIVE
ACTIVE
10/8/2010 None
4/19/2011 None
N/A
N/A
UNION
SC
ACTIVE
10/11/2010 None
N/A
SILVERDALE
WA
ACTIVE
4/1/2013 None
N/A
SAN ANTONIO TX
ACTIVE
8/11/2011 None
N/A
HENDERSON
ACTIVE
10/5/2011 None
N/A
TX
License
Number
Physician Name
P0102
N2203
P2310
MUHAMMAD, ASIF ALI, MD
MUJAHID, AMBREEN , MD
MUJURUKI, CEPHAS , MD
N3195
P0257
MUKAI, AI , MD
MUKALEL, JESSEN JAMES, MD
P0258
MUKALEL, NINON JAMES, MD
N3913
dicaid
dicaid
Agreement
End Date
Designated)
PULMONARY
CRITICAL CARE
6/15/2011
6/15/2016 MEDICINE
2/6/2009
3/1/2012
PAIN
MANAGEMENT/REHAB
5/29/2009
5/29/2014 MED
7/1/2011
PEDIATRIC
7/1/2011
7/1/2016 NEUROLOGY
MIDAND
AMARILLO
TX
TX
PAIN MEDICINE
AUSTIN
HOUSTON
TX
TX
SLEEP MEDICINE
HOUSTON
SLEEP MEDICINE
FAMILY PRACTICE
6/4/2010
9/1/2011
N5268
N3917
P0770
MUKKAMALA, SRIDEVI, MD
MULLICAN, DAVID RYAN, MD
MULUKUTLA, VENKATACHALAM ,
MD
MULVEHILL, SHARON ANN, MD
MUMMADI, VIJAYA LAKSHMI-DEVI,
MD
MUMTAZ, MEHNAZ , MD
MUNDRA, VISHAL, MD
N9611
MUNIR, SYED MUZAFFAR, MD
N6936
P5849
MUNITZ, ELAINE MARIE, MD
MUNIZ, MANUEL R, MD
7/1/2010
3/15/2013
P1369
MUNOZ, JAVIER LUIS, MD
11/4/2011
P2900
MUNSHI, SATVIK BHARGAV, MD
4/13/2012
N3918
MUPPIDI, SRIKANTH , MD
MURALIDHARA, KESTURKOPPAL ,
MD
8/21/2009
HEMATOLOGY/ONCOL
11/4/2016 OGY
INTERNAL MEDICINE
PHYSICAL MED. &
PAIN MEDICINE
NEUROMUSCULAR
8/21/2014 NEUROLOGY
DISEASE
8/26/2011
8/26/2016
N6514
P0916
N3916
H2632
P0857
PHYSICAL MED. &
8/21/2009
5/15/2013
OBSTETRICS
2/5/2010
8/21/2009
8/15/2011
CHILD AND
ADOLESCENT
5/2/2016 PSYCHIATRY
5/2/2011
Disciplinary
Status Date
N/A
N/A
N/A
ACTIVE
ACTIVE
6/4/2009 None
7/7/2011 None
N/A
N/A
TX
ACTIVE
7/7/2011 None
N/A
TX
ACTIVE
9/21/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
3/12/2012 None
N/A
6/4/2010 None
9/7/2011 None
N/A
N/A
8/31/2009 None
7/8/2013 None
N/A
N/A
SAN ANTONIO TX
TULSA
OK
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
2/5/2010 None
10/29/2009 None
8/19/2011 None
N/A
N/A
N/A
5/2/2011 None
N/A
DENISON
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
7/1/2010 None
4/1/2013 None
N/A
N/A
HOUSTON
NEW
ORLEANS
TX
ACTIVE
11/10/2011 None
N/A
LA
ACTIVE
4/23/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
9/9/2009 None
N/A
8/26/2011 None
N/A
FT. WORTH
BILLINGS
TX
MT
NUCLEAR MEDICINE
PSYCHIATRY
Page 186 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
6/15/2011 None
3/10/2009 None
3/19/2012 None
CLINICAL
NEUROPHYSIOLOGY LAREDO
PEDIATRIC
OTOLARYNGOLOGY GALVESTON
SPINAL CORD
INJURY MEDICINE
8/21/2009
3/1/2012
Practice City
LICENSE
ISSUED
ACTIVE
ACTIVE
MUKAMANA, GRACE, MD
MUKERJI, SHRADDHA SIDDHARTH,
MD
P2311
8/21/2014
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
License
Number
Physician Name
N9917
MURDOCK, RYAN C, MD
N8047
N8327
MURILLO, BORIS ALBERTO, MD
MURILLO, HORACIO , MD
N2679
MURILLO, TOMAS ALBERTO , MD
P3654
P6876
N8128
MURPHY, ANDREW CHARLES, MD
MURPHY, LORI MAE, MD
MURRAY, MATTHEW CHARLES,
MD
P0104
MURRAY, MATTHEW FOREST, MD
N8493
MURRAY, REBECCA LOUISE, MD
P6685
MURTHY, SANTOSH BHASKAR, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
6/3/2011
PULMONARY
CRITICAL CARE
10/29/2010
10/29/2015 MEDICINE
12/15/2010
PEDIATRIC EMER MED
4/3/2009
4/3/2014 (PEDS)
PEDIATRICS
EMERGENCY
6/15/2012
6/15/2017 MEDICINE
6/3/2013
OPHTHALMOLOGY
SPORTS MEDICINE
11/15/2010
(ORTH SURG)
MUSCULOSKELETAL
6/15/2011
6/15/2016 RADIOLOGY
RADIOLOGY
CARDIOTHORACIC
1/18/2011
ANESTHESIOLOGY
5/15/2013
5/15/2018 NEUROLOGY
N4604
MURTHY, SMITHA , MD
11/6/2009
P2312
N3922
MURTY, RAMANA M, MD
MUSACCHIO, NAJAH SENNO, MD
3/1/2012
8/21/2009
3/1/2017 CARDIOLOGY
P5850
MUSGRAVE, WILLIAM LARKIN, DO
3/15/2013
N3923
MUSHER, BENJAMIN, MD
8/21/2009
P0259
P4987
P5692
P4895
MUSSO, MARYFRANCES , DO
MUSTAFA, ARSHAD , MD
MUTHAPPA, DIVYA, MD
MUZAFFAR, SUMERA, MD
N2353
MYERS, DERRICK MARLIN, MD
G6576
N4607
MYERS, STUART IRA, MD
MYUNG, CHANG RYUL, MD
6/14/2013
11/6/2009
N7847
NABBOUT, LARA , MD
10/1/2010
7/1/2011
11/30/2012
3/1/2013
11/15/2012
4/3/2009
HEMATOLOGY/ONCOL
8/21/2014 OGY
PEDIATRIC
EMERGENCY
4/3/2014 MEDICINE
PSYCHOSOMATIC
MEDICINE
INTERVENTIONAL
CARDIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
PHILADELPHIA PA
ACTIVE
SAN ANTONIO TX
LICENSE
ISSUED
ACTIVE
FORT WORTH TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/10/2011 None
N/A
10/29/2010 None
12/21/2010 None
N/A
N/A
ACTIVE
4/8/2009 None
N/A
DALLAS
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
6/21/2012 None
6/7/2013 None
N/A
N/A
BIRMINGHAM
ACTIVE
LICENSE
ISSUED
12/14/2010 None
N/A
6/15/2011 None
N/A
AL
HOUSTON
TX
ACTIVE
1/21/2011 None
N/A
BALTIMORE
MD
ACTIVE
6/7/2013 None
N/A
AUSTIN
TX
STEUBENVILL
E
OH
DALLAS
TX
ACTIVE
11/12/2009 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
3/15/2012 None
9/28/2009 None
N/A
N/A
3/15/2013 None
N/A
9/14/2009 None
N/A
TX
ACTIVE
OTOLARYNGOLOGY
HOUSTON
DALLAS
BANDERA
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
5/22/2009 None
N/A
NE
TX
ACTIVE
ACTIVE
6/20/2013 None
2/5/2010 None
N/A
N/A
TX
ACTIVE
10/19/2010 None
N/A
FAMILY MEDICINE
GENERAL VASCULAR
6/14/2018 VASCULAR SURGERY SURGERY
LINCOLN
HARLINGEN
GERIATRICS 10/1/2015 INTERNAL MEDICINE INTERNAL MEDICINE HOUSTON
Page 187 of 300
7/6/2011
12/10/2012
3/8/2013
11/20/2012
License
Number
Physician Name
N6518
NABORS, VENUS JOLLY, MD
N9474
NACHIMUTHU, SENTHIL, MD
N6519
NADELLA, RAMA, MD
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
6/4/2010
6/4/2015 GYNECOLOGY
4/15/2011
6/4/2010
10/1/2010
NADIMPALLI, CHITRA V, MD
N5897
NAEEM, MUHAMMAD, MD
4/9/2010
N6520
NAEEM, MUHAMMAD, MD
6/4/2010
6/4/2015 NEUROLOGY
N8549
NAEEM, SAIMA, MD
1/18/2011
N5898
P1370
P4790
NAEEM, SAJIDA NIGHAT, MD
NAGA, OSAMA IBRAHIM, MD
NAGALLA, SUBHASH K S, MD
4/9/2010
11/4/2011
11/1/2012
P3556
P6474
NAGARAJ, SUDHA, MD
NAGARAJ, SUMA, MD
6/8/2012
5/1/2013
N8048
M0836
NAGAVI, AMIR SEAN, MD
NAGDA, RABIA MEHR, MD
5/1/2018 PEDIATRICS
EMERGENCY
10/29/2015 MEDICINE
P3209
NAGPAL, AMEET SINGH, MD
5/15/2012
N9753
N3925
N3926
NAGY, SZILVIA, MD
NAHAR, JANE , MD
NAHAR, JULIE , MD
5/16/2011
8/21/2009
8/21/2009
P4684
N3927
NAHAR, RIADUN , MD
NAHAR, RUBY , MD
N8228
NAHOURAII, RICHARD A, MD
P6046
P0917
NAIDU, KARTHIK, MD
NAIK, JAEE, MD
P7679
NAIK, SEEMA GIRISH, MD
10/15/2012
8/21/2009
12/1/2010
4/1/2013
9/1/2011
8/15/2013
Practice City
INTERNAL MEDICINE
6/4/2015 NEPHROLOGY
N7848
10/29/2010
11/6/2009
Secondary Specialty
(Self-Designated)
PORT
ARTHUR
OBSTETRICS AND
CRITICAL CARE
12/1/2015 (TRAUMA)
ORAL &
MAXILLOFACIAL
4/1/2018 SURGERY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
6/4/2010 None
N/A
4/15/2011 None
N/A
6/4/2010 None
N/A
10/15/2010 None
N/A
4/9/2010 None
N/A
6/4/2010 None
N/A
1/18/2011 None
N/A
4/9/2010 None
12/1/2011 None
11/7/2012 None
N/A
N/A
N/A
6/8/2012 None
5/3/2013 None
N/A
N/A
10/29/2010 None
11/19/2009 None
N/A
N/A
HOUSTON
TX
HOUSTON
TX
ACTIVE
5/22/2012 None
N/A
SAN ANTONIO
TULSA
TULSA
WICHITA
FALLS
TX
OK
OK
ACTIVE
ACTIVE
ACTIVE
5/19/2011 None
9/11/2009 None
9/30/2009 None
N/A
N/A
N/A
TX
ACTIVE
ACTIVE
12/10/2012 None
10/5/2009 None
N/A
N/A
TX
ACTIVE
1/11/2011 None
N/A
4/1/2013 None
9/9/2011 None
N/A
N/A
8/20/2013 None
N/A
HOSPITALIST
BEAUMONT
PEORIA
TX
IL
URGENT CARE
MEDICINE
PHYSICAL MED. &
REHABILITATION
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
SLEEP MEDICINE
OTHER SPECIALTY
Registration
Status Date
Disciplinary
Status of
Texas
License
GERIATRICS
HEMATOLOGY 8/15/2018 INTERNAL MEDICINE INTERNAL MEDICINE SAN ANTONIO TX
Page 188 of 300
LICENSE
ISSUED
ACTIVE
ACTIVE
License
Number
P7165
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRIC
HEMATOLOGY/ONCOL
7/1/2013
7/1/2018 OGY
N8129
NAIK, SWATI , MD
NAINA, HARRIS VEZHAPPILLY
KUNJALI, MD
NAIR, ARCHANA UNNIKRISHNAN,
MD
N6522
NAIR, BINU S, MD
6/4/2010
N7316
NAIR, JYOTI GOVINDAN, MD
8/2/2010
N6523
NAIR, KIRAN DEV, DO
6/4/2010
P7680
NAIR, RINSY, MD
8/15/2013
P6223
N3203
NAIR, SAJAY, MD
NAIR, SINDHU , MD
4/12/2013
5/29/2009
PEDIATRIC
EMERGENCY
N3204
NAIR, SUNEESH GOPALAN , MD
5/29/2009
P4600
NAJAM, FERHANA, MD
10/1/2012
N7952
P1372
P2741
NAJERA, ROBERT MATTHEW, MD
NAKAMURA, LEE MAYUMI, MD
NAKIB, EVAN ZEB, MD
N7643
N5273
NALLAGATLA, SASIKANTH, MD
P1478
N7467
NALLU, SAGARIKA, MD
NAM, YOUNG-JAE , MD
N7644
N1011
N8959
P2042
NAMBIAR, ANOOP MANAYIL, MD
NAN, BICHENG , MD
NANGHA, PANNABEN, MD
NANGIA, SAMIR KUMAR, MD
9/1/2010
11/15/2010
10/15/2010
11/4/2011
4/2/2012
2/5/2010
11/15/2011
8/16/2010
9/1/2010
8/29/2008
3/1/2011
2/1/2012
9/1/2015
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
HEMATOLOGY INTERNAL MEDICINE DALLAS
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
TX
ACTIVE
7/25/2013 None
N/A
TX
ACTIVE
9/16/2010 None
N/A
1/5/2011 None
N/A
6/4/2010 None
N/A
8/2/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
8/26/2013 None
N/A
4/12/2013 None
6/26/2009 None
N/A
N/A
11/15/2015 INTERNAL MEDICINE GERIATRICS
WOODLANDS TX
HEMATOLOGY/ONCOL
6/4/2015 OGY
INTERNAL MEDICINE
8/2/2015 PEDIATRICS
PLASTIC &
RECONSTRUCTIVE
10/15/2015 SURGERY
11/4/2016 RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
FAMILY PRACTICE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
TX
LICENSE
ISSUED
ACTIVE
HOUSTON
WICHITA
INTERNAL MEDICINE FALLS
TX
ACTIVE
6/19/2009 None
N/A
TX
ACTIVE
10/2/2012 None
N/A
TX
LA
ACTIVE
ACTIVE
ACTIVE
10/20/2010 None
11/10/2011 None
4/12/2012 None
N/A
N/A
N/A
2/5/2010 None
N/A
PEDIATRICS
HOSPITALIST
PULMONARY
CRITICAL CARE
MEDICINE
GALVESTON
MONROE
PULMONARY
CRITICAL CARE
MEDICINE
PEDIATRIC
SLEEP MEDICINE
PULMONARY
CRITICAL CARE
9/1/2015 MEDICINE
INTERNAL MEDICINE
2/1/2017 NEPHROLOGY
INTERNAL MEDICINE
Page 189 of 300
LICENSE
ISSUED
DALLAS
TX
ACTIVE
ACTIVE
12/6/2011 None
9/16/2010 None
N/A
N/A
SAN ANTONIO
ANN ARBOR
WORCESTER
DESOTO
TX
MI
MA
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
9/6/2010
9/30/2008
4/20/2011
2/10/2012
N/A
N/A
N/A
N/A
None
None
None
None
License
Number
Physician Name
N5276
P1113
P1904
NANGRANI, CHAITALI D, MD
NAQVI, ALI HASNAIN, MD
NAQVI, ERUM, MD
N8130
NARANG, ASHISH, DO
N6525
NARANG, SANDEEP K, MD
NARAYAN, ARCHANA RAMANATH,
MD
NARRA, PAVAN, MD
N6941
N4611
dicaid
dicaid
Agreement
End Date
Designated)
2/5/2010
10/3/2011
1/17/2012
11/15/2010
6/4/2010
7/1/2010
11/6/2009
EMERGENCY
11/15/2015 MEDICINE
PEDIATRIC FORENSIC
6/4/2015 MEDICINE
ALLERGY AND
7/1/2015 IMMUNOLOGY
11/6/2014 RADIOLOGY
P1114
N7565
NARULA, ARUN, MD
NARULA, JINNY, MD
10/3/2011
8/27/2010
10/3/2016
8/27/2015
N8825
P1374
NARVAEZ, JUAN CARLOS, MD
NASIR, SOBIA , MD
2/15/2011
11/4/2011
2/15/2016
11/4/2016
P6224
P0451
NASON, ROBERT, MD
NASREEN, JOHRA, MD
4/12/2013
7/15/2011
4/12/2018
7/15/2016
P6877
NASTOUPIL, LORETTA JO, MD
6/3/2013
6/3/2018
P4685
NASUR, ALI MOHAMED, MD
10/15/2012
10/15/2017
P3394
NATARAJAN, BALAKRISHNAN, MD
6/1/2012
6/1/2017
N5279
NATHAN, SRIRAM S, MD
2/5/2010
N8430
NATIVIDAD, TORIBIO TOMAS, MD
1/3/2011
TM00495 NATTELL, DANIEL F, MD
N8431
NATTIV, ROY, MD
N6526
P7166
N7468
N9392
NAVAI, NEEMA , MD
NAVALKELE, DIGVIJAYA D, MD
NAVARRO, ALEXANDER MA, MD
NAYAK, TANAYA, MD
HOSPITALIST
HOSPITALIST
PEDIATRICS
PEDIATRICS
NEONATALNEONATALPERINATAL
PERINATAL MEDICINE MEDICINE
FAMILY PRACTICE
OBSTETRICS AND
GYNECOLOGY
FAMILY PRACTICE
PEDIATRIC
OTOLARYNGOLOGY
OTOLARYNGOLOGY
FAMILY MEDICINE
HOSPITALIST
HEMATOLOGY/ONCOL
OGY
INTERVENTIONAL
ELECTROPHYSIOLO
CARDIOLOGY
GY
PALLIATIVE
INTERNAL MEDICINE MEDICINE
12/15/2011
1/3/2011
2/5/2015 CARDIOLOGY
ORTHOPEDIC
1/3/2016 SURGERY
DIAGNOSTIC
1/3/2016 PEDIATRICS
6/4/2010
7/1/2013
6/4/2015 UROLOGY
7/1/2018 NEUROLOGY
8/16/2010
4/8/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
AMARILLO
TX
ACTIVE
SAN ANTONIO TX
ACTIVE
ALGONQUIN
IL
MCALLEN
TX
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
12/9/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
7/13/2010 None
2/1/2010 None
N/A
N/A
10/10/2011 None
9/10/2010 None
N/A
N/A
2/15/2011 None
11/8/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
AUSTIN
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
4/23/2013 None
8/8/2011 None
N/A
N/A
HOUSTON
ACTIVE
6/7/2013 None
N/A
10/25/2012 None
N/A
6/1/2012 None
N/A
2/5/2010 None
N/A
1/7/2011 None
N/A
12/22/2011 None
1/6/2011 None
N/A
N/A
6/4/2010 None
7/8/2013 None
N/A
N/A
8/16/2010 None
4/21/2011 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
BIRMINGHAM
AL
HOUSTON
TX
PEDIATRICS
UROLOGIC
ONCOLOGY
Page 190 of 300
Disciplinary
Status Date
2/5/2010 None
10/13/2011 None
1/31/2012 None
ACTIVE
GERIATRIC
MEDICINE (INTERNAL
MED)
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P7320
NAYAR, TUSHAR, MD
7/15/2013
N9103
P4896
NAYYAR, SANJAY, MD
NAZ, TABASSUM, MD
3/15/2011
11/15/2012
P6475
P0919
NAZARIO, MICHELLE O, MD
NAZHA, AZIZ , MD
P0859
P7520
N3206
NAZIM, MUHAMMAD HARIS, MD
NDUKWE, STELLA ADA-IHUOMA,
MD
NEAD, JENNIFER ANNE , MD
P2743
5/1/2013
9/1/2011
8/26/2011
NEAMAN, KEITH C, MD
4/2/2012
4/2/2017 HAND SURGERY
P0771
NEDELCU, ELENA , MD
8/15/2011
P7521
NEDELKA, MICHELE, MD
P0106
NEEDHAM, JACK NEWTON JR, MD
N5905
NEELA, SANGEETA , MD
P6225
NEELAND, IAN JASON, MD
N9274
NEELY, GREGORY MARK, MD
TM00531 NEELY, PHILIP E, MD
N4613
NEFF, JUSTIN MICHAEL, MD
P0264
N9921
P3395
NEFF, ROBERT SWANSON II, MD
NEGI, SMITA INDRASINGH, MD
NEGRON RODRIGUEZ, BRENDALI ,
MD
P7820
NEIL, ERIN ELIZABETH, DO
N6528
NEIL, GIANNI Y, MD
6/15/2011
4/9/2010
4/12/2013
4/1/2011
11/15/2012
8/15/2016 PATHOLOGY
RADIATION
8/1/2018 ONCOLOGY
ORTHOPEDIC
4/1/2016 SURGERY
7/1/2011
6/3/2011
6/1/2012
8/30/2013
6/4/2010
FAMILY MEDICINE
HOSPITALIST
PLASTIC &
RECONSTRUCTIVE
SURGERY
HEMATOLOGY
(PATHOLOGY)
PASADENA
HOUSTON
NV
ACTIVE
ACTIVE
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
CARDIOVASCULAR
DISEASES
ORTHOPEDIC
TRAUMA
CARDIOLOGY
NEUROMUSCULAR
DISEASE
Page 191 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/15/2013 None
N/A
3/18/2011 None
12/17/2012 None
N/A
N/A
5/14/2013 None
9/13/2011 None
N/A
N/A
8/26/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
8/8/2013 None
6/8/2009 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
4/3/2012 None
N/A
HOUSTON
TX
ACTIVE
8/23/2011 None
N/A
KERRVILLE
TX
ACTIVE
LICENSE
ISSUED
8/5/2013 None
N/A
6/15/2011 None
N/A
ACTIVE
4/20/2010 None
N/A
DIAGNOSTIC
4/9/2015 RADIOLOGY
EMERGENCY
11/6/2014 MEDICINE
ORTHOPEDIC
7/1/2016 SURGERY
11/6/2009
Practice City
GASTROENTEROLOG
3/15/2016 Y
N LAS VEGAS
PEDIATRIC
5/1/2018 PSYCHIATRY
PSYCHIATRY
HOUSTON
9/1/2016 INTERNAL MEDICINE INTERNAL MEDICINE HOUSTON
TRAUMATIC
8/1/2013
5/29/2009
8/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
DALLAS
TX
ACTIVE
4/16/2013 None
N/A
DALLAS
TX
ACTIVE
4/19/2011 None
N/A
MADISON
AL
ACTIVE
11/29/2012 None
N/A
DALLAS
TX
ACTIVE
11/16/2009 None
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
7/6/2011 None
6/13/2011 None
N/A
N/A
SPRING
TX
ACTIVE
6/4/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
9/2/2013 None
N/A
6/4/2010 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
6/3/2011
6/3/2016 MEDICINE
N9922
NEILSBERG, JASON RYAN, DO
N6530
NELIUS, THOMAS , MD
6/4/2010
6/4/2015 UROLOGY
N5906
NELLIGAN, RUSSELL WILLIAM, MD
4/9/2010
N4614
N9923
NELSON, BRIAN SHAWN, MD
NELSON, DAVID BRYAN, MD
L1948
N1798
N8695
NELSON, JOELY GENE, MD
NELSON, WAYNE KENT, MD
NEMARUGOMMULA, NANDA
KISHORE , MD
NEMATI, PROSHAD, MD
NEMUNAITIS, GREGORY ALLAN,
MD
N9614
NERO, ALECIA, MD
5/2/2011
N6533
NESSELROADE, RYAN DAVID, MD
6/4/2010
N1014
P3213
P6226
NEW, AARON ROBERT, MD
NEWBERRY, ROBERT CARROLL,
F1170
MD
NEWMAN, JACK NATHANIEL JR,
TM00546 MD
N2684
NEWMAN, JOSEPH MATTHEW, MD
11/6/2009
6/3/2011
2/5/2010
12/12/2008
8/29/2008
5/15/2012
2/4/2011
6/3/2016
8/16/2015 PATHOLOGY
CARDIOVASCULAR
7/1/2018 IMAGING
NEYMAN, EDWARD, MD
6/1/2012
P6227
NG, KENNETH , DO
4/12/2013
N8696
P5694
P6228
NGO, BICH-THY NGUYEN, MD
NGO, THUY-TRANG THI, MD
NGO, TIN CHAN, MD
2/4/2011
3/1/2013
4/12/2013
N6534
NGO, VINH, MD
6/4/2010
6/1/2017 RADIOLOGY
PEDIATRIC
GASTROENTEROLOG
4/12/2018 Y
DIAGNOSTIC
RADIOLOGY
6/3/2011 None
N/A
6/4/2010 None
N/A
4/20/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
11/17/2009 None
6/14/2011 None
N/A
N/A
2/5/2010 None
2/9/2009 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
11/27/2008 None
5/17/2012 None
N/A
N/A
2/4/2011 None
N/A
ACTIVE
LICENSE
ISSUED
6/6/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
4/29/2013 None
N/A
ACTIVE
9/23/2010 None
N/A
ACTIVE
7/11/2013 None
N/A
CO
TX
UROLOGIC SURGERY
FRISCO
Disciplinary
Status Date
ACTIVE
OTOLOGY/NEUTOTO
LOGY
FLORESVILLE TX
ANESTHESIOLOGY
SPINAL CORD
INJURY MEDICINE
HEMATOLOGY 5/2/2016 INTERNAL MED - PEDS INTERNAL MEDICINE DALLAS
TX
EMERGENCY
6/4/2015 MEDICINE
8/16/2010
P3396
DENVER
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
PHYSICAL MED. &
4/12/2018 UROLOGY
4/3/2009
Practice City
UROLOGIC SURGERY
DALLAS
EMERGENCY
MEDICINE
EDEN
GYNECOLOGY
DALLAS
4/12/2013
7/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
DALLAS
TX
ACTIVE
4/8/2009 None
N/A
WILMETTE
IL
ACTIVE
6/5/2012 None
N/A
4/12/2013 None
N/A
2/4/2011 None
3/6/2013 None
4/22/2013 None
N/A
N/A
N/A
6/4/2010 None
N/A
2/4/2016 GERIATRICS
4/12/2018 UROLOGY
HOUSTON
EMERGENCY
6/4/2015 MEDICINE
Page 192 of 300
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
N8960
NGO, YEN HOANG, MD
N5283
P6687
N4616
P7167
N8961
NGUYEN, AIMEE LE, MD
NGUYEN, ANDY HUY, DO
NGUYEN, ANH TAT, MD
NGUYEN, BAOCHAN, MD
NGUYEN, BICH-MAY, MD
N3942
N6943
P4897
NGUYEN, CAYLI TAM PHUONG, DO
NGUYEN, CHARLES MINH, MD
NGUYEN, DAT, DO
P1793
NGUYEN, DOANH, MD
P6478
N3208
P0107
N3943
P1116
N3944
dicaid
dicaid
Agreement
End Date
Designated)
3/1/2011
2/5/2010
5/15/2013
11/6/2009
7/1/2013
3/1/2011
2/5/2015
5/15/2018
11/6/2014
7/1/2018
3/1/2016
8/21/2009
7/1/2010
11/15/2012
8/21/2014
7/1/2015
11/15/2017
1/2/2012
1/2/2017
NGUYEN, DOMINIC DUNG, MD
NGUYEN, DUY HOANG, MD
NGUYEN, ETHAN QUAN, MD
NGUYEN, GIANG LE , MD
NGUYEN, HANH NGOC, DO
NGUYEN, HUONG GIANG, MD
5/1/2013
5/29/2009
6/15/2011
8/21/2009
10/3/2011
8/21/2009
5/1/2018
5/29/2014
6/15/2016
8/21/2014
10/3/2016
8/21/2014
N3945
NGUYEN, HUY QUOC, MD
8/21/2009
P1794
NGUYEN, JENNIFER LIEN, DO
FAMILY
N5908
P4493
N3946
NGUYEN, KHANH TUNG, MD
NGUYEN, KIM YEN THI, MD
NGUYEN, KIMTUYEN NGOC, MD
TM00341 NGUYEN, MICHAEL HUY, MD
1/2/2012
4/9/2010
9/17/2012
8/21/2009
2/5/2010
P5855
NGUYEN, MICHAEL LY, MD
3/15/2013
P7821
NGUYEN, MICHAEL VAN, MD
8/30/2013
P2320
N7729
P1796
NGUYEN, MINH DUC, MD
NGUYEN, MINH T, MD
NGUYEN, NAM H, DO
3/1/2012
9/15/2010
1/2/2012
P2043
NGUYEN, NHAT QUANG, MD
2/1/2012
UROGYNECOLOGY
INTERNAL MEDICINE
FAMILY MEDICINE
OPHTHALMOLOGY
FAMILY MEDICINE
PHYSICAL MED. &
REHABILITATION
INTERNAL MEDICINE
INTERNAL MEDICINE
ALLERGY AND
IMMUNOLOGY
RADIATION
ONCOLOGY
ANESTHESIOLOGY
GENERAL PRACTICE
FAMILY MEDICINE
FAMILY MEDICINE
ANESTHESIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
DALLAS, TX
OBSTETRICS AND
GYNECOLOGY
FAMILY MEDICINE
IRVING
DALLAS
MAYWOOD
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
TX
ACTIVE
ACTIVE
IL
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
DALLAS
HUMBLE
WACO
DALLAS
TX
TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
HOSPITALIST
INTERNAL MEDICINE
RADIATION
ONCOLOGY
OTOLARYNGOLOGY
FAMILY PRACTICE
CRITICAL CARE
MEDICINE (IM)
PEARLAND
DALLAS
TX
TX
2/5/2015 RADIOLOGY
EMERGENCY
8/30/2018 MEDICINE
3/1/2017 SURGERY
ORTHOPEDICS
1/2/2017 PSYCHIATRY
GASTROENTEROLOG
2/1/2017 Y
INTERNAL MEDICINE
Page 193 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/4/2011 None
N/A
2/5/2010
5/20/2013
11/19/2009
7/5/2013
3/15/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
9/14/2009 None
7/13/2010 None
12/3/2012 None
N/A
N/A
N/A
2/1/2012 None
N/A
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
ACTIVE
8/26/2009 None
N/A
ACTIVE
2/8/2012 None
N/A
4/26/2010 None
10/10/2012 None
9/15/2009 None
N/A
N/A
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
5/1/2013
6/4/2009
6/17/2011
9/15/2009
10/19/2011
9/23/2009
BEDFORD
TX
ACTIVE
4/15/2013 None
N/A
SUGAR LAND
TX
ACTIVE
9/9/2013 None
N/A
TX
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
3/1/2012 None
9/22/2010 None
1/9/2012 None
N/A
N/A
N/A
2/1/2012 None
N/A
HOUSTON
GALVESTON
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
OTOLARYN & FACIAL
12/1/2010
WARREN
EMERGENCY
11/15/2010
11/15/2015 MEDICINE
IRVING
4/1/2011
URGENT CARE 8/30/2013
FAMILY PRACTICE
LAFAYETTE
N8230
NGUYEN, NINH HAM, DO
N8131
N9275
NGUYEN, PHUC HONG, DO
NGUYEN, QUAN TRUNG, DO
P7822
NGUYEN, STEVEN XUAN, MD
N3210
NGUYEN, SUN , MD
5/29/2009
P7823
N6945
N4620
NGUYEN, THI THANH, DO
NGUYEN, THOMAS MINH, MD
NGUYEN, THY PHUONG, MD
8/30/2013
7/1/2010
11/6/2009
N2689
NGUYEN, TONY KIM , MD
4/3/2009
11/6/2014 NEUROLOGY
SPORTS MEDICINE
4/3/2014 (ORTH SURG)
N6537
NGUYEN, TRUNG HIEU, MD
6/4/2010
P4794
P1117
NGUYEN, TUAN ANH NGOC, MD
NGUYEN, VINH QUANG, MD
11/1/2012
10/3/2011
P0455
P5856
N3947
NGUYEN, VU ANH, MD
NIAZI, NADIA, MD
NICHITA, SIMONA , MD
7/15/2011
3/15/2013
8/21/2009
P7522
NICHOLLS, LAUREN ANNE, MD
8/1/2013
P2044
NICHOLS, PATRICK MARSHALL, DO
2/1/2012
P1675
P0860
NIEGOS, FREDERICK BOADO, MD
NIELAND, MELISSA JANE, MD
P2904
NIEMAND, NOELLE ROSE, MD
4/13/2012
EMERGENCY
11/1/2017 MEDICINE
PEDIATRIC
EMERGENCY
7/15/2016 MEDICINE (EM)
PEDIATRIC
HEMATOLOGY/ONCOL
8/1/2018 OGY
EMERGENCY
2/1/2017 MEDICINE
ENDOCRINOLOGY,
DIABETES AND
OBSTETRICS AND
N3949
NIEN SHY, YIH-DAR, MD
8/21/2009
N8049
NIETO, KIRSTEN GIBBS, MD
12/15/2011
8/26/2011
10/29/2010
HOUSTON
Registration
Status of
Practice
Texas
State
License
CLEVELAND
ACTIVE
12/14/2010 None
N/A
TX
ACTIVE
ACTIVE
12/9/2010 None
4/22/2011 None
N/A
N/A
LA
ACTIVE
9/2/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/26/2009 None
N/A
8/30/2013 None
7/14/2010 None
1/12/2010 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/29/2009 None
N/A
6/4/2010 None
N/A
OH
INTERNAL MEDICINE
FAMILY MEDICINE
Disciplinary
Status Date
MI
FAMILY
PRACTICE/OMM
INTERNAL MEDICINE NEW BRITAIN CT
ORTHOPEDICS
Registration
Status Date
Disciplinary
Status of
Texas
License
RICHMOND
SUGAR LAND
TX
TX
ACTIVE
ACTIVE
11/5/2012 None
10/25/2011 None
N/A
N/A
SUGAR LAND
TX
LAS CRUCES
NM
ACTIVE
ACTIVE
ACTIVE
7/21/2011 None
3/20/2013 None
8/26/2009 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
8/23/2013 None
N/A
GENERAL PRACTICE EL PASO
TX
ACTIVE
2/7/2012 None
N/A
INTERNAL MEDICINE VICTORIA
BELTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
1/3/2012 None
8/31/2011 None
N/A
N/A
4/13/2012 None
N/A
11/19/2009 None
N/A
10/29/2010 None
N/A
NEPHROLOGY
Page 194 of 300
License
Number
P3656
Physician Name
NIETO, ROMAN JR, MD
N5285
P0643
P1375
N4622
NIEVES CRUZ, BEDFORD , MD
NIGAM, RUPESH , MD
NIJHAWAN, DEEPAK, MD
NIKAM, NAVIN SRINIVAS, MD
P2322
N9924
NINAN, RONY , MD
NIRAJ, ASHUTOSH, MD
N3211
P1676
P6689
NIRMAL, KAVITA , MD
NISAN, ABIGAIL, MD
NISHAT, ARIFA, MD
P0266
NIU, MARY C, MD
NNEBE, FLORENCE ONYEBUCHI,
MD
N3950
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
6/15/2012
6/15/2017 MEDICINE
2/5/2010
8/1/2011
11/4/2011
11/6/2009
3/1/2012
6/3/2011
5/29/2009
12/15/2011
5/15/2013
7/1/2011
8/21/2009
P7322
NOEL, TAMEKA LACHELLE, MD
7/15/2013
P0774
8/15/2011
N8231
NOFZIGER, ADAM VON, MD
NOONAN, PATRICK THOMAS JR,
MD
P5112
NOORDA, SCOTT J, DO
12/17/2012
P5112
NOORDA, SCOTT J, DO
12/17/2012
P5112
NOORDA, SCOTT J, DO
12/17/2012
12/1/2010
P4603
N5912
NORA, FREDERICK, MD
NORMAN, NATALIE DIANNE, MD
10/1/2012
4/9/2010
P0861
NORSWORTHY, TWYLA NASH, MD
8/26/2011
N8132
NORTHEIM, JUSTIN R, DO
P7323
NORTHROP, SARA CHRISTINE, DO
11/15/2010
7/15/2013
2/5/2015
8/1/2016
11/4/2016
11/6/2014
PEDIATRICS
INTERNAL MEDICINE
ONCOLOGY
INTERNAL MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
ACTIVE
NEONATALPERINATAL
MEDICINE
12/1/2015 RADIOLOGY
FAMILY
FAMILY
FAMILY
ANATOMIC/CLINICAL
10/1/2017 PATHOLOGY
OBSTETRICS AND
EMERGENCY
11/15/2015 MEDICINE
OBSTETRICS AND
NEURORADIOLOGY
HEMATOLOGY
(PATHOLOGY)
Page 195 of 300
TX
TX
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
TX
MI
Registration
Status Date
Disciplinary
Status of
Texas
License
6/21/2012 None
2/5/2010
8/8/2011
11/9/2011
11/25/2009
Disciplinary
Status Date
N/A
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
3/8/2012 None
6/10/2011 None
N/A
N/A
TX
TX
LA
ACTIVE
ACTIVE
ACTIVE
8/5/2009 None
1/9/2012 None
6/4/2013 None
N/A
N/A
N/A
TX
ACTIVE
7/27/2011 None
N/A
EL PASO
TX
ACTIVE
8/27/2009 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
9/9/2013 None
N/A
8/15/2011 None
N/A
HOUSTON
DALLAS
NEUROMUSCULAR
DISEASE
HOUSTON
INTERNAL MEDICINE DETROIT
3/1/2017 NEUROLOGY
6/3/2016 CARDIOLOGY
HEMATOLOGY/ONCOL
5/29/2014 OGY
INTERNAL MEDICINE SAN ANTONIO
INTERNAL MEDICINE ABILENE
CALHOUN
PEDIATRICS,
7/1/2016 PEDIATRICS
CARDIOLOGY
HOUSTON
EMERGENCY
8/15/2016 MEDICINE
Registration
Status of
Practice
Texas
State
License
TEMPLE
TX
ACTIVE
12/6/2010 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
DENISON
TX
ACTIVE
ACTIVE
10/30/2012 None
4/22/2010 None
N/A
N/A
MAGNOLIA
AR
ACTIVE
9/6/2011 None
N/A
DENTON
TX
ACTIVE
11/19/2010 None
N/A
MANSFIELD
TX
ACTIVE
7/18/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
INTERVENTIONAL
DIAGNOSTIC
6/15/2012
6/15/2017 RADIOLOGY
RADIOLOGY
P3657
NOURANIFAR, RABIN, MD
N7645
NOVAK, THOMAS EDWARD, MD
9/1/2010
P2746
NOVOSAD, LAURIE SUSAN, MD
NOYA, ANTHONY ARMANDO
DENIS, MD
NTENDE, HENRY WAKIKU, MD
NUCKOLS, MATTHEW CHARLES,
MD
NUILA, RICARDO ERNESTO, MD
NUNEZ URIBURU, HUMBERTO
FERNANDO, MD
NUNEZ, RIGOBERTO NICHOLAS,
MD
4/2/2012
P4795
P0645
P2501
N3952
N1022
P1571
P1005
P7824
N5913
NUNEZ, TIMOTHY CHARLES, MD
NUNEZ-WALLACE, KAREN ROSA,
MD
UROLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
4/4/2012 None
N/A
FAMILY MEDICINE
FORT HOOD
TX
TX
ACTIVE
ACTIVE
11/6/2012 None
8/25/2011 None
N/A
N/A
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/15/2012 None
N/A
9/1/2010 None
N/A
11/1/2012
8/1/2011
9/1/2015 PEDIATRIC UROLOGY
COLON AND RECTAL
4/2/2017 SURGERY
EMERGENCY
11/1/2017 MEDICINE
8/1/2016 NEPHROLOGY
3/15/2012
8/21/2009
EL PASO
HOUSTON
TX
TX
ACTIVE
ACTIVE
4/5/2012 None
9/22/2009 None
N/A
N/A
8/29/2008
PHYSICAL MED. &
MISSION
TX
ACTIVE
9/26/2008 None
N/A
SAN ANTONIO TX
FORT SAM
HOUSTON
TX
ACTIVE
1/16/2012 None
N/A
ACTIVE
9/30/2011 None
N/A
9/5/2013 None
N/A
4/9/2010 None
N/A
ACTIVE
9/10/2008 None
N/A
CARDIOVASCULAR
SURGERY
ACTIVE
4/15/2013 None
N/A
OBSTETRICS AND
GYNECOLOGY
LICENSE
ISSUED
6/14/2013 None
N/A
12/16/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
11/6/2012 None
N/A
ACTIVE
11/19/2012 None
N/A
ACTIVE
1/17/2011 None
N/A
12/1/2011
9/15/2011
8/30/2013
8/30/2018 NEUROLOGY
4/9/2010
CRITICAL CARE
(SURGERY)
ACTIVE
LICENSE
ISSUED
N1023
NUNLEY, AMANDA WITT, MD
NUR, MARCELA MARIA DEL PILAR,
MD
8/29/2008
P6230
NURI, MUHAMMAD ATAUNUR
KHALID, MD
4/12/2013
P7010
NURUDEEN, SAHADAT KEMI, MD
6/14/2013
ADOLESCENT
8/29/2013 MEDICINE - PD
PEDIATRIC
CARDIOTHORACIC
4/12/2018 SURGERY
REPRODUCTIVE
ENDOCRINOLOGY
6/14/2018 AND INFERTILITY
P1572
12/1/2011
N5288
NUSBAUM, DEREK MATTHEW, MD
NWABUDE, IKECHUKWU
ALOYSIUS, MD
2/5/2010
P4686
NWACHUKWU, CHISOM DAISY, MD
10/15/2012
P4898
NWAEZE, IJEOMA O, MD
11/15/2012
SPORTS MEDICINE
N8329
NWAGBATA, EBELECHUKWU, MD
12/15/2010
PEDIATRICS
MIDLAND
HOUSTON
HOSPITALIST
SPORTS MEDICINE
(FAMILY PRACTICE)
Page 196 of 300
MILWAUKEE
TX
TX
WI
ACTIVE
LICENSE
ISSUED
License
Number
P0456
Physician Name
P2907
NWAKUCHE, UZOMA , MD
NWANEGBO, EDWARD CHIEKE,
MD
NWANKWO, CHRISTIAN CHIDUBE,
MD
P1573
NWOKOLO, FELIX
CHUKWUEMEKA, MD
P5437
NYATSANZA, IGNATIUS, MD
N4632
OARIS, AKEELA , MD
N5292
OBAFEMI, ADEBISI IDOWU, MD
P2906
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
HEMATOLOGY/ONCOL
7/15/2011
7/15/2016 OGY
INTERNAL MEDICINE BAYTOWN
EAST
4/13/2012
LANSING
4/13/2012
12/1/2011
2/1/2013
11/6/2009
2/5/2010
P2502
OBERG, ERIK DONALD, MD
3/15/2012
P6481
OBERTON, SELBY BRENT, MD
5/1/2013
P2747
P7524
OBIE, OGADINMA IJEOMA, MD
OBI-OFODILE, DANIEL
CHINWEUBA, MD
P1799
N1026
OBOKHARE, IZI DANIEL, MD
OBREGON, JACINTO AMARU, MD
1/2/2012
8/29/2008
N5289
O'BRIEN, MICHAEL FRANCIS, MD
2/5/2010
P0457
P5696
7/15/2011
3/1/2013
N1808
OCHANI, POONAM, MD
OCHOA, JOSE MARIA IV, MD
OCHOA, ROBERT ANTHONY JR,
MD
12/12/2008
P5295
O'DEA, COLIN MAGNUSON, MD
1/15/2013
P5113
ODEDRA, RANDHIRJI P, MD
12/17/2012
P5113
12/17/2012
NEPHROLOGY
CHILD AND
ADOLESCENT
PSYCHIATRY
ST. LOUIS
Registration
Status of
Practice
Texas
State
License
ACTIVE
8/18/2011 None
N/A
MI
ACTIVE
4/24/2012 None
N/A
MO
ACTIVE
4/23/2012 None
N/A
12/1/2011 None
N/A
2/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
11/18/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/13/2012 None
N/A
5/1/2013 None
N/A
ACTIVE
4/16/2012 None
N/A
ACTIVE
8/5/2013 None
N/A
ACTIVE
ACTIVE
1/6/2012 None
10/8/2008 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
8/26/2011 None
3/6/2013 None
N/A
N/A
ACTIVE
12/29/2008 None
N/A
1/22/2013 None
N/A
12/17/2012 None
N/A
1/29/2013 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
FORT SAM
HOUSTON
INTERNAL MEDICINE
4/2/2012
5/1/2018 CARDIOLOGY
EMERGENCY
4/2/2017 MEDICINE
8/1/2013
FAMILY PRACTICE
COLON AND RECTAL
SURGERY
ORTHOPEDIC
SURGERY OF THE
2/5/2015 SPINE
PHYSICAL MED. &
EL PASO
TX
TX
ORTHOPEDIC
SURGERY
EMERGENCY
1/15/2018 MEDICINE
EMERGENCY
12/17/2017 MEDICINE
EMERGENCY
12/17/2017 MEDICINE
Page 197 of 300
LICENSE
ISSUED
TEMPLE
TX
SAN ANTONIO TX
MCHENRY
Disciplinary
Status Date
TX
EMERGENCY
3/15/2017 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
IL
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
12/17/2012
12/17/2017 MEDICINE
8/1/2011
ANESTHESIOLOGY
EMERGENCY
8/15/2013
8/15/2018 MEDICINE
FAMILY PRACTICE 5/1/2013
EMERGENCY MED
P5113
P0646
ODELL, ROBERT H JR, MD
P7683
ODOM, GEOFFREY LYLE, MD
P6482
N2694
ODOM, LYNDA GAYLE, MD
ODULAJA, KOLAWOLE
ADEMUYIWA, MD
P7525
ODUMOSU, OLUTONI , MD
N1404
OFORDEME, KENECHUKWU , MD
N6544
OFORI, STANLEY, MD
6/4/2010
N9926
OGBEBOR, CHRISTIAN EFOSA, MD
6/3/2011
P7526
OGBOGU, KENE, MD
8/1/2013
N9927
OGBONNA, MARTINA, MD
6/3/2011
HOSPITALIST
P7826
OGBU, CHIJIOKE EJIOFOR, MD
8/30/2013
NEPHROLOGY
H9391
P1203
OGHAFUA, GREGSON OROBOSA,
MD
OGUNDIPE, OLUKEMI , MD
P1204
OGUNFUWA, ADEKUNLE SUNDAY,
MD
OGUNTUGA, OLUSESAN ABIODUN,
MD
P6231
OH, MICHAEL CHIHONG, MD
N8699
O'HARA, WALTER WALDO JR, MD
P2152
OI, SEIJO, MD
N5293
4/3/2009
8/1/2013
10/10/2008
6/15/2011
10/17/2011
2/5/2010
10/17/2011
4/12/2013
2/4/2011
2/10/2012
Practice City
MCHENRY
IL
FORT WORTH TX
FAMILY MEDICINE
NEUROLOGICAL
4/12/2018 SURGERY
CARDIOVASCULAR
2/4/2016 SURGERY
CONROE
ST LOUIS
PARK
INTERNAL MEDICINE ROCKWALL
HOUSTON
GERIATRIC
MEDICINE (INTERNAL
MED)
PAWHUSKA
SAN
FRANCISCO
CARDIOVASCULAR
SURGERY
PULMONARY
MEDICINE
Page 198 of 300
KERRVILLE
Disciplinary
Status Date
1/29/2013 None
8/8/2011 None
N/A
N/A
ACTIVE
8/19/2013 None
N/A
ACTIVE
5/7/2013 None
N/A
ACTIVE
LICENSE
ISSUED
4/13/2009 None
N/A
8/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
1/19/2009 None
N/A
6/4/2010 None
N/A
TX
ACTIVE
6/15/2011 None
N/A
MN
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
ACTIVE
8/8/2013 None
N/A
6/3/2011 None
N/A
8/30/2013 None
N/A
6/15/2011 None
10/26/2011 None
N/A
N/A
LICENSE
ISSUED
2/5/2010 None
N/A
10/25/2011 None
N/A
4/26/2013 None
N/A
2/4/2011 None
SEE
PREVIOUS
2/21/2012 ORDER
N/A
DENVER CITY TX
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
GERIATRICS
EMERGENCY
10/10/2013 MEDICINE
CARDIOVASCULAR
6/15/2016 DISEASES
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
OK
ACTIVE
CA
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
2/13/2012
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
4/9/2010
4/9/2010
3/1/2012
8/29/2008
4/9/2015
4/9/2015
3/1/2017
8/29/2013
Secondary Specialty
(Self-Designated)
NEONATALPERINATAL MEDICINE PEDIATRICS
ORTHOPEDICS
ANESTHESIOLOGY
NEUROLOGY
N5917
N5918
P2327
N1030
OJADI, VALLIER CHIDI, MD
OJEYEMI, DAPO, MD
OK, JOHN YOUNG, MD
OKAI, ANNETTE , MD
N6547
OKEA, REMIGIUS NWABUEZE, MD
6/4/2010
N7154
OKECHUKWU, CHRISTOPHER , MD
7/15/2010
EMERGENCY
7/15/2015 MEDICINE
P4604
N5920
OKIN, ABIODUN ADEJUMOKE, MD
OKOLO, EKENE IFEANYI, MD
10/1/2012
4/9/2010
P2045
2/1/2012
J4947
OKONKWO, FRANCIS ARINZE, MD
OKORIE, BERTRAM
IHEANYICHUKWU, MD
8/15/2011
EMERGENCY
8/15/2016 MEDICINE
P7324
OKORO, NOSAKHARE , MD
7/15/2013
P7173
P5697
P6483
N1032
OKORODUDU, JANAI MARLIS, MD
OKOYE, EKENE IFEYINWA, MD
OKUDA, DARIN T, MD
OKUMBOR, DAVID OSAGIE, MD
P1006
Practice City
BALTIMORE
DALLAS
Registration
Status of
Practice
Texas
State
License
MD
TX
INTERNAL MEDICINE
4/29/2010
4/27/2010
3/13/2012
9/8/2008
Disciplinary
Status Date
None
None
None
None
N/A
N/A
N/A
N/A
6/4/2010 None
N/A
7/15/2010 None
N/A
ODESSA
TUCSON
TX
AZ
ACTIVE
ACTIVE
10/16/2012 None
4/23/2010 None
N/A
N/A
FORT SMITH
AR
ACTIVE
2/20/2012 None
N/A
AZ
ACTIVE
8/19/2011 None
N/A
MESA
WICHITA
FALLS
TX
ACTIVE
7/22/2013 None
N/A
7/1/2013
3/1/2013
5/1/2013
8/29/2008
7/1/2018
3/1/2018
5/1/2018
8/29/2013
DALLAS
HOUSTON
DALLAS
GREENVILLE
TX
TX
TX
TX
8/14/2013
3/11/2013
5/7/2013
9/8/2008
None
None
None
None
N/A
N/A
N/A
N/A
9/15/2011
12/14/2011 None
N/A
2/1/2013
6/14/2013
2/1/2018 PSYCHIATRY
N9394
OKUNDAYE, EBIMA CLIFFORD, MD
OKUSAGA, OLAOLUWA OLOLADE,
MD
OLABODE, IRENE SEYI, DO
OLADELE-AJOSE, OLUFEMI
TAIWO, MD
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DELINQUEN
T-NON
PAYMENT
P5858
OLAECHEA, JASOR, MD
3/15/2013
N4636
OLAJIDE, BOLANLE ABIMBOLA, MD
OLALOWO, OLOYEDE OLABODE,
MD
OLARTE MERIDA, KAREN EVELIN,
MD
11/6/2009
4/13/2012
2/1/2013
P5441
P7014
P2908
P5442
4/8/2011
FAMILY PRACTICE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
FAMILY MEDICINE
PATHOLOGY
NEUROLOGY
FAMILY PRACTICE
INTERNAL MEDICINE
EMERGENCY
MEDICINE
HOUSTON
TX
ACTIVE
ACTIVE
2/26/2013 None
6/18/2013 None
N/A
N/A
WEST
BURLINGTON
IA
ACTIVE
LICENSE
ISSUED
4/20/2011 None
N/A
3/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
12/2/2009 None
N/A
4/13/2012 None
N/A
2/7/2013 None
N/A
INTERNAL MEDICINE
BROOKLYN
NY
INTERNAL MEDICINE
Page 199 of 300
DETROIT
MI
ACTIVE
License
Number
P2328
N4637
Physician Name
OLATUNBOSUN, SADIAT KRISTINA,
MD
OLAYA, JORGE EDUARDO , MD
dicaid
dicaid
Agreement
End Date
Designated)
3/1/2012
11/6/2009
P7523
O'LEARY, MANDY FLANNERY, MD
8/1/2013
P5216
OLIPHANT, NEKESHA, MD
1/4/2013
H9393
P3401
N3217
OLIVER, ROBERT VERNE, MD
OLIVIER, HOLLY , DO
OLIVO, JENNY MARIA, MD
12/1/2010
6/1/2012
5/29/2009
P7827
8/30/2013
N1033
OLMSTED, THOMAS JAMES, DO
OLOBATUYI, KENISHA DANSEY,
MD
OLOSUNDE, AYOTOKUNBO
OLAITAN, MD
OLOTU, ADETOKUNBO
OLUWAYEMISI, MD
OLOUGHLIN, TERENCE JOSEPH,
MD
OLOWOOKERE, AYODELE
OLAWALE, MD
OLSEN, ALEX BRYAN, MD
OLSON, KELLY ANN, MD
OLUBANJO, OLUGBEMINIYI
IBIDAPO, MD
N6549
N8232
OLWENY, EPHREM ODOY, MD
OLYMPIA, CHRISTIAN LOMIO, MD
6/4/2010
12/1/2010
P4991
N9276
OMER, SHUAB , MD
OMIDVAR, KAMRAN, MD
P6486
OMMANI, SOPHIA JOSEFINA, MD
N9757
ONCIU, MIHAELA , MD
N9928
P1121
P1007
N7319
N4638
N9618
P5699
6/3/2011
3/1/2017 PSYCHIATRY
BLOOD
BANKING/TRANSFUSI
ON MEDICINE
HOUSTON
8/1/2018 PATHOLOGY
FAMILY
PRACTICE/PSYCHIATR
1/4/2018 Y
EMERGENCY
12/1/2015 MEDICINE
6/1/2017 PSYCHIATRY
FAMILY MEDICINE
EMERGENCY
8/30/2018 MEDICINE
6/3/2016
9/15/2011
11/6/2009
5/2/2011
3/1/2013
8/2/2015 RADIOLOGY
OBSTETRICS AND
3/1/2018 PEDIATRICS
8/29/2008
11/30/2012
4/1/2011
5/1/2013
5/16/2011
Practice City
GALVESTONT TX
EAGLE PASS TX
10/3/2011
8/2/2010
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
DALLAS
TX
FORT WORTH TX
SHIPROCK
NM
GYNECOLOGY
GASTROENTEROLOG
Y
NEURORADIOLOGY
ACTIVE
ACTIVE
3/12/2012 None
1/27/2010 None
N/A
N/A
ACTIVE
8/19/2013 None
N/A
ACTIVE
2/4/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
12/6/2010 None
6/6/2012 None
7/10/2009 None
N/A
N/A
N/A
8/30/2013 None
N/A
ACTIVE
LICENSE
ISSUED
6/13/2011 None
N/A
10/3/2011 None
N/A
TX
ACTIVE
10/14/2011 None
N/A
ATLANTA
GA
ACTIVE
9/24/2010 None
N/A
CINCINNATI
OH
ACTIVE
ACTIVE
ACTIVE
11/20/2009 None
5/9/2011 None
3/8/2013 None
N/A
N/A
N/A
9/15/2008 None
N/A
6/4/2010 None
12/14/2010 None
N/A
N/A
12/7/2012 None
4/6/2011 None
N/A
N/A
7/9/2013 None
N/A
5/16/2011 None
N/A
FORT WORTH TX
UROLOGY
EULESS
INTERNAL MEDICINE
CORPUS
CHRISTI
ANATOMIC
PATHOLOGY
Page 200 of 300
Disciplinary
Status Date
EL PASO
UNSPECIFIED
THORACIC
CARDIOVASCULAR
11/30/2017 SURGERY
OBSTETRICS AND
5/1/2018 GYNECOLOGY
HEMATOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
N1811
ONETO, JULIETA MARIANA, MD
P3214
ONG, JINFON , MD
P6487
ONI, MARGARET BOSEDE, MD
P7685
ONISKO, NANCY SUZANNE, DO
N5295
ONOCHIE, NNENNA NKIRU, MD
ONYEAMA, CHARLES
OKECHUKWU, MD
N8331
N8829
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
DIAGNOSTIC
12/12/2008
RADIOLOGY
PEDIATRIC
5/15/2012
5/15/2017 NEUROLOGY
PHYSICAL MED. &
5/1/2013
EMERGENCY
8/15/2013
8/15/2018 MEDICINE
2/5/2010
12/15/2010
2/15/2011
P3403
P4495
N1035
ONYIKE, AHAM ELEMUWA, MD
ONYIORAH, CLETUS EMEKA, MD
9/17/2012
8/29/2008
N5296
2/5/2010
N4871
OO, THEIN HLAING, MD
OOMMEN, KALARICKAL JOSEPH,
MD
11/6/2009
11/6/2014 NEUROLOGY
N7853
OOMMEN, SMITHA ELIZABETH, MD
10/1/2010
N5297
OPARA, EMMANUEL CHIWUEZE,
MD
N4631
P7016
O'PATRY, SEAN DAVID , DO
OPPELTZ, RICHARD, MD
11/6/2009
6/14/2013
P1122
ORAN, BETUL , MD
10/3/2011
P5116
ORANGE, JORDAN SCOTT, MD
12/17/2012
P5116
12/17/2012
6/1/2012
2/5/2010
DALLAS
TX
HOSPITALIST
ONYEBUEKE, IKENNA FELIX, MD
ONYENEKWU, NKEIRUKA NGOZI,
MD
Practice City
Registration
Status of
Practice
Texas
State
License
GRANTS
PULMONARY
CRITICAL CARE
MEDICINE
EMERGENCY
MEDICINE
HEMATOLOGY/ONCOL
2/5/2015 OGY
SAN ANTONIO TX
NEUROPHYSIOLOGYNEUROLOGY
LUBBOCK
ONCOLOGY
GALVESTON
GERIATRIC
MEDICINE (INTERNAL
MED)
CLEBURNE
TX
Disciplinary
Status Date
ACTIVE
2/3/2009 None
N/A
ACTIVE
5/18/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/13/2013 None
N/A
8/15/2013 None
N/A
2/5/2010 None
N/A
12/30/2010 None
N/A
2/15/2011 None
N/A
6/11/2012 None
N/A
12/16/2012 None
9/17/2008 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ABILENE
EMERGENCY
11/6/2014 MEDICINE
HEMATOLOGY/ONCOL
10/3/2016 OGY
PEDIATRICS,
ALLERGY &
ALLERGY AND
IMMUNOLOGY
PEDIATRICS,
ALLERGY &
ALLERGY AND
IMMUNOLOGY
Page 201 of 300
NM
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
DELINQUEN
T-NON
PAYMENT
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
11/16/2009 None
N/A
TX
ACTIVE
10/13/2010 None
N/A
2/5/2010 None
N/A
LICENSE
ISSUED
TX
ACTIVE
ACTIVE
1/29/2010 None
6/27/2013 None
N/A
N/A
MINNEAPOLIS MN
ACTIVE
10/20/2011 None
N/A
LICENSE
ISSUED
12/17/2012 None
N/A
1/22/2013 None
N/A
HOUSTON
TX
ACTIVE
License
Number
P5116
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRICS,
ALLERGY &
ALLERGY AND
12/17/2012
IMMUNOLOGY
N7854
ORDINARIO, MARIA MARGARITA,
MD
P0460
ORDONEZ, ADOLFO JOSE, MD
P7175
ORDONEZ, EDGARDO, MD
7/1/2013
N5298
ORDYNA, NICHOLAS JOHN, MD
2/5/2010
N3214
O'REILLY, KATIE CAIRNS, MD
5/29/2009
N6552
6/4/2010
P7527
ORENGO, LUIS ANTONIO, MD
ORILLOSA, SUSAN JEDA
DOLLOSA, MD
P1379
ORNELAS, JACOB D, MD
11/4/2011
N9758
ORRELL, JOSHUA JUDD, MD
5/16/2011
N5299
P5117
ORSI, CARISSE MENDOZA, MD
ORTEGA BARNETT, JUAN RAMON,
MD
MD
MD
N5924
ORTEGA, RAE LYNN, MD
N7567
ORTEGA, RAUL ENRIQUE, MD
8/27/2010
N3963
P6232
ORTEGA, SCOTTY, MD
ORTIZ, CHRISTIAN , MD
8/21/2009
4/12/2013
N8134
ORTIZ, CHRISTOPHER ERIC, MD
H8781
ORTIZ, IRENE ELIZABETH, MD
P5117
P5117
10/1/2010
7/15/2011
EMERGENCY
7/1/2018 MEDICINE
8/1/2013
2/5/2010
12/17/2012
12/17/2012
12/17/2012
4/9/2010
11/15/2010
7/1/2011
ANATOMIC/CLINICAL
5/29/2014 PATHOLOGY
PHYSICAL MED. &
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
1/22/2013 None
N/A
10/1/2010 None
N/A
TX
ACTIVE
7/20/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
7/16/2013 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
6/12/2009 None
N/A
6/4/2010 None
N/A
PATHOLOGY
ROUND ROCK TX
OBSTETRICS AND
EMERGENCY
5/16/2016 MEDICINE
PEDIATRIC
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
EMERGENCY
4/9/2015 MEDICINE
WEBSTER
TX
ACTIVE
8/2/2013 None
N/A
LUBBOCK
TX
ACTIVE
12/8/2011 None
N/A
SEGUIN
TX
ACTIVE
LICENSE
ISSUED
5/24/2011 None
N/A
2/5/2010 None
N/A
FAMILY PRACTICE 8/21/2014 HOSPITALIST
EMERGENCY MED
EMERGENCY
URGENT CARE
11/15/2015 MEDICINE
MEDICINE
GERIATRIC
7/1/2016 PSYCHIATRY
PSYCHIATRY
Page 202 of 300
DENTON
TX
LUFKIN
GALVESTON
TX
ACTIVE
12/18/2012 None
N/A
GALVESTON
TX
ACTIVE
12/18/2012 None
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
12/18/2012 None
N/A
N/A
ACTIVE
4/9/2010 None
SEE
PREVIOUS
9/10/2010 ORDER
TX
ACTIVE
ACTIVE
9/2/2009 None
4/18/2013 None
N/A
N/A
TEMPLE
TX
ALBUQUERQU
E
NM
ACTIVE
1/21/2011 None
N/A
ACTIVE
8/1/2011 None
N/A
8/30/2010
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PULMONARY
CRITICAL CARE
8/29/2008
8/29/2013 MEDICINE
SLEEP MEDICINE
8/21/2009
8/21/2014 NEUROLOGY
SLEEP MEDICINE
P7686
ORTIZ-CANTILLO, KATHIA
ALEXANDRA, MD
ORTSTADT, JEFFREY LEON, MD
ORUE QUINTANA, VALERIA
ALEJANDRA, MD
P0461
OSAMA, FAUZIA KHALIDA, MD
7/15/2011
MEDICAL
TOXICOLOGY
(EMERGENCY
7/15/2016 MEDICINE)
N4641
OSAYANDE, AMIMI SANDRA , MD
11/6/2009
N5301
OSBORN, AMBIKA NICOLE, MD
N1036
N3965
8/15/2013
2/5/2010
OSBORN, CLINTON ROGER, MD
N5926
OSHODI, GANIYU OLUKAYODE, MD
4/9/2010
N6553
OSKOUI, GASSEM ZEBARJADI, MD
6/4/2010
P7829
8/30/2013
N1408
OSLUND, SCOTT ALLEN, MD
OSMAN, HOUSSAM GALAL ELDIN,
MD
OSMAN, KWABENA AGYAPONG,
MD
OSORIO, FEDERICO GUILLERMO,
MD
10/10/2008
CARDIOTHORACIC
ANESTHESIOLOGY
N8053
OSORIO, HECTOR JAIRO, MD
10/29/2010
INTERNAL MEDICINE
M6325
OSORIO-GIRALDO, ALONSO
JAVIER, MD
4/9/2010
EMERGENCY
4/9/2015 MEDICINE
N2702
OSOWO, AYODELE TEMITOPE, MD
4/3/2009
P1380
OST, LOREN BARRETT, MD
11/4/2011
N7470
OSTROUKHOVA, MARINA, MD
8/16/2010
P3404
3/15/2013
6/1/2012
CARDIAC
ELECTROPHYSIOLOG
4/9/2015 Y
CARDIOLOGY
EMERGENCY
8/30/2018 MEDICINE
ABDOMINAL
SURGERY
ALLERGY AND
INTERNAL MEDICINE
Page 203 of 300
Disciplinary
Status Date
ACTIVE
ACTIVE
9/30/2008 None
9/2/2009 None
N/A
N/A
HOUSTON
ACTIVE
8/19/2013 None
N/A
LICENSE
ISSUED
7/15/2011 None
N/A
DALLAS
11/16/2009 None
N/A
2/5/2010 None
N/A
9/6/2013 None
N/A
4/14/2010 None
N/A
6/4/2010 None
N/A
TX
TX
ACTIVE
LICENSE
ISSUED
WEST LAKE
HILLS, TX
TX
ACTIVE
WACO
TX
ACTIVE
LICENSE
ISSUED
WACO
TX
ACTIVE
9/6/2013 None
N/A
DALLAS
TX
ACTIVE
3/29/2013 None
N/A
ACTIVE
6/15/2012 None
N/A
10/20/2008 None
N/A
10/29/2010 None
N/A
4/9/2010 None
N/A
9/9/2009 None
N/A
11/17/2011 None
N/A
8/16/2010 None
N/A
6/1/2017 PEDIATRICS
FAMILY PRACTICE
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANTONIO TX
DALLAS
TX
2/5/2015 PEDIATRICS
P7828
P5859
8/30/2013
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
MOUNT
PLEASANT
HOUSTON
SULPHUR
SPRINGS
TX
IA
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
N9759
Physician Name
OSUCHUKWU, GEORGE AMECHI,
MD
N3967
N4642
P7176
OSUJI, NONYEREM NNENNA , MD
OSWAL, ALOK , MD
OTERO LUGO, ARLYN , MD
P3560
OTHEE, MANDEEP SINGH, MD
6/8/2012
N5305
OTI, IFEATU UCHENNA, MD
2/5/2010
N9106
OTT, SUSAN MARIE, DO
3/15/2011
N3221
OTTNEY, MICHAEL DAVID, DO
5/29/2009
P2910
P1381
OTTO, CHRISTIAN, MD
OTULANA, OLAKUMBI B, DO
4/13/2012
11/4/2011
N7734
OU, SAI-HONG IGNATIUS, MD
9/15/2010
N7855
OUTTEN, STEPHEN SINCLAIR, DO
10/1/2010
P6691
OUYANG, DA , MD
5/15/2013
EMERGENCY
4/13/2017 MEDICINE
HEMATOLOGY/ONCOL
9/15/2015 OGY
INTERNAL MEDICINE ORANGE
EMERGENCY
10/1/2015 MEDICINE
HOUSTON
EMERGENCY
5/15/2018 MEDICINE
DALLAS
N7471
N8233
P5700
OVALLE, ALEJANDRO , MD
OVERBEEKE, CORNELL, MD
OVERTURF, STEVEN , MD
8/16/2010
12/1/2010
3/1/2013
12/1/2015 RADIOLOGY
N8554
OWEIS, THOMAS DANIEL, MD
1/18/2011
N5928
OWEN, ANN BURLESON, MD
4/9/2010
P1911
OWENS, ERIN MACDONALD, MD
DIAGNOSTIC
4/9/2015 RADIOLOGY
EMERGENCY
1/17/2017 MEDICINE
P5218
P6234
OWENS, JEANNIE, DO
OWENS, RICHARD ALEXANDER,
MD
P0648
OWENSBY, TRACEY LYNN, MD
5/16/2011
8/21/2009
11/6/2009
7/1/2013
PHYSICAL MED. &
1/17/2012
1/4/2013
4/12/2013
8/1/2011
2/5/2015 NEPHROLOGY
ORTHOPEDIC
3/15/2016 SURGERY
EMERGENCY
4/12/2018 MEDICINE
OBSTETRICS AND
8/1/2016 GYNECOLOGY
Practice City
NEPHROLOGY
PAIN MEDICINE
EMERGENCY
MEDICINE
Page 204 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/16/2011 None
N/A
8/31/2009 None
11/24/2009 None
8/27/2013 None
N/A
N/A
N/A
SAN ANTONIO TX
MCKINNEY
TX
HARLINGEN
TX
ACTIVE
ACTIVE
ACTIVE
ODESSA
ACTIVE
LICENSE
ISSUED
6/18/2012 None
N/A
2/5/2010 None
N/A
TX
ACTIVE
3/23/2011 None
N/A
IL
ACTIVE
1/4/2010 None
N/A
TX
ACTIVE
ACTIVE
4/27/2012 None
11/11/2011 None
N/A
N/A
CA
ACTIVE
10/4/2010 None
N/A
TX
ACTIVE
10/14/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
5/20/2013 None
N/A
8/16/2010 None
12/17/2010 None
4/2/2013 None
N/A
N/A
N/A
INTERNAL MEDICINE
HARLINGEN
EMERGENCY
MEDICINE
PARIS
HOUSTON
TRAUMATIC
SURGERY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
BATAVIA
IL
MAUMEE
OH
ACTIVE
2/7/2011 None
N/A
KENNER
LA
ACTIVE
5/3/2010 None
N/A
ARLINGTON
SULPHUR
SPRINGS
TX
ACTIVE
2/29/2012 None
N/A
TX
ACTIVE
1/8/2013 None
N/A
ANN ARBOR
MI
4/19/2013 None
N/A
HARLINGEN
TX
ACTIVE
LICENSE
ISSUED
8/1/2011 None
N/A
License
Number
N8963
Physician Name
P0110
OWOLABI, MICHAEL SANMI, MD
OYEKANMI, OYEKUNLE
ADEBOWALE, MD
N9619
N7320
P1576
OYIRIARU, DANIEL IKECHUKWU,
MD
OZA, VIJAY CHANDULAL, MD
PACHA, OMAR , MD
P5862
N3406
PACKER, ALLAN DEAN, MD
PACKER, MILTON , MD
N8055
PADDA, MANMEET SINGH, MD
P7177
PADI, ABHILASH, MD
N8332
PADILLA, LUIS ALFONSO, MD
N2227
PADILLA-WILLIAMS, LILIANA, MD
N6554
PAEZ, ANA MARIA, MD
P2751
N3223
P3215
PAGAN FERRER, JUAN , MD
PAGAN, CARMEN JUDITH, MD
PAGAN, SHARON JAELL, MD
N6555
P1802
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
OBSTETRICS AND
3/1/2011
3/1/2016 SURGERY
GYNECOLOGY
OCCUPATIONAL
6/15/2011
GERIATRIC
MEDICINE (FAMILY
5/2/2011
PRACTICE)
8/2/2010
FAMILY PRACTICE
12/1/2011
12/1/2016 GENERAL PRACTICE DERMATOLOGY
EMERGENCY
3/15/2013
3/15/2018 MEDICINE
5/29/2009
GASTROENTEROLOG
10/29/2010
10/29/2015 Y
INTERNAL MEDICINE
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
GYNECOLOGIC
12/15/2010
12/15/2015 ONCOLOGY
OBSTETRICS AND
2/6/2009
2/6/2014 GYNECOLOGY
PEDIATRIC
6/4/2010
6/4/2015 PEDIATRICS
ENDOCRINOLOGY
4/2/2012
5/29/2009
5/15/2012
PAGANI, MARCO, MD
PAING, SOE, MD
6/4/2010
1/2/2012
6/4/2015 NEPHROLOGY
N2709
PAK, EUGENE , MD
4/3/2009
N8333
PAL, JAY DEEP, MD
12/15/2010
N1817
P3050
PAL, JEFFREY , MD
PAL, SUNITA , MD
N7155
PALACIO URAN, DIANA MARIA, MD
12/12/2008
5/1/2012
7/15/2010
4/3/2014 NEUROLOGY
THORACIC
CARDIOVASCULAR
12/15/2015 SURGERY
PEDIATRICS
HOSPITALIST
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
AUSTIN
TX
HOUSTON
TX
ROWLETT
TX
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
EL PASO
TX
ACTIVE
MCALLEN
TX
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
LA JOYA
TX
ABILENE
TX
LACONIA
WICHITA
FALLS
NH
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
TRANSPLANT
SURGERY
DIAGNOSTIC
7/15/2015 RADIOLOGY
Page 205 of 300
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
STEAMBOAT
SPRINGS
CO
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
3/1/2011 None
N/A
6/15/2011 None
N/A
5/19/2011 None
8/18/2010 None
12/14/2011 None
N/A
N/A
N/A
4/1/2013 None
6/18/2009 None
N/A
N/A
10/29/2010 None
N/A
7/1/2013 None
N/A
12/22/2010 None
N/A
2/17/2009 None
N/A
6/4/2010 None
UNDER
BOARD
4/3/2012 ORDER
6/22/2009 None
5/17/2012 None
N/A
3/19/2012
N/A
N/A
6/4/2010 None
1/9/2012 None
N/A
N/A
4/10/2009 None
N/A
12/15/2010 None
N/A
12/24/2008 None
5/22/2012 None
N/A
N/A
7/15/2010 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1803
PALACIO, CARLOS ANDRES, MD
1/2/2012
N9107
PALACIOS, JORGE MAURICIO, MD
N7321
PALENCIA, DON DAVID, DO
N3224
PALISCH, ANDREW , MD
P6883
PALISCH, CATHERINE , MD
6/3/2013
N8437
PALLADINO, HUMBERTO , MD
1/3/2011
P6236
N9760
N3225
PALM, DANIEL BRIAN, MD
PALMER, CELESTE D, MD
PALMER, LOLITA VERNETTE, MD
4/12/2013
5/16/2011
5/29/2009
N8964
PALMER, ROBERT ANDREW, MD
3/1/2011
DIAGNOSTIC
3/1/2016 RADIOLOGY
P5864
P5219
PALOMBARO, GEREMIE, DO
PAN, EDWARD, MD
3/15/2013
1/4/2013
1/4/2018 NEURO-ONCOLOGY
N6556
PAN, JEN-JUNG, MD
6/4/2010
6/4/2015 HEPATOLOGY
P7178
PAN, RUTH, MD
7/1/2013
N7856
PANAYIDES, KYRIACOS , MD
N1412
PANCHAL, ROHIT P, MD
N5931
PANDE, HEMANT, MD
4/9/2010
P5220
P0649
PANDEY, MANJU KHATIWADA, MD
PANDIAN, ANBU VALAVAN, MD
1/4/2013
8/1/2011
P3405
PANDIT, SINDHU, MD
6/1/2012
8/2/2010
DIAGNOSTIC
5/29/2014 RADIOLOGY
ORTHOPEDIC
6/3/2018 SURGERY
PLASTIC &
RECONSTRUCTIVE
1/3/2016 SURGERY
10/1/2010
10/10/2008
Practice City
3/15/2011
5/29/2009
Secondary Specialty
(Self-Designated)
CARDIOTHORACIC
ANESTHESIOLOGY
REPRODUCTIVE
ENDOCRINOLOGY
AND INFERTILITY
PLASTIC SURGERY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
1/2/2012 None
N/A
AR
ACTIVE
4/12/2011 None
N/A
ARLINGTON
TX
ACTIVE
9/9/2010 None
N/A
ACTIVE
6/12/2009 None
N/A
HOUSTON
TX
ACTIVE
6/6/2013 None
N/A
EL PASO
TX
2/9/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
4/12/2013 None
6/3/2011 None
8/31/2009 None
N/A
N/A
N/A
3/1/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
3/19/2013 None
1/31/2013 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/12/2013 None
N/A
10/1/2010 None
N/A
ACTIVE
11/17/2008 None
N/A
ACTIVE
4/29/2010 None
N/A
MUSCULOSKELETAL
RADIOLOGY
OPHTHALMOLOGY RECONST SURGERY EL PASO
NEUROLOGY
DALLAS
GASTROENTEROLOG
Y
INTERNAL MED PREV MED
HOUSTON
TX
TX
TX
PULMONARY
CRITICAL CARE
10/10/2013 MEDICINE
INTERNAL MEDICINE GREENWOOD MS
GASTROENTEROLOG
4/9/2015 Y
INTERNAL MEDICINE LEESVILLE
LA
Page 206 of 300
Disciplinary
Status Date
LITTLE ROCK
FAMILY MEDICINE
PHYSICAL MED. &
Registration
Status Date
Disciplinary
Status of
Texas
License
LEWISVILLE
TEMPLE
TX
TX
ACTIVE
ACTIVE
2/28/2013 None
8/5/2011 None
N/A
N/A
HOUSTON
TX
ACTIVE
6/13/2012 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
GASTROENTEROLOG
6/4/2010
6/4/2015 Y
PEDIATRICS
N6557
PANDRANGI, BHARANI, MD
N5312
PANDYA, HIMANSHU , MD
N1039
PANDYA, MAYANK , MD
8/29/2008
OBSTETRICS &
GYNECOLOGICAL
8/29/2013 SURGERY
P1382
PANDYA, SUNIL RAMESH, MD
11/4/2011
P5444
PANITHI, RANJANI, MD
2/1/2013
N7647
N2711
PANJA, SRINIVAS RAO, MD
PANKAJ, SHILPA THAKKAR, MD
9/1/2010
4/3/2009
2/1/2018 PEDIATRICS
ENDOCRINOLOGY,
DIABETES AND
9/1/2015 METABOLISM
4/3/2014 PEDIATRICS
N6558
6/4/2010
6/4/2015 PEDIATRICS
N5314
PANKRATZ, MICHAL MARIE, MD
PANTOJA ROJAS, CELIA ESTELA,
MD
2/5/2010
N2230
P3407
PANWAR, MONICA , MD
PAPAILA, ELIZABETH M, MD
2/6/2009
6/1/2012
P3051
P4900
5/1/2012
11/15/2012
3/1/2011
6/3/2013
P0650
PAPAVASILIOU, PAVLOS , MD
PARACHA, FARRAH TASNIM, MD
PARDO RUIZ, FERNANDO JAVIER,
MD
PAREDES, JOHN ENRIQUE, DO
PAREKH, NINAD DHANVANTRAY,
MD
SURGICAL
5/1/2017 ONCOLOGY
8/1/2011
P0463
N2231
P1804
PARETS-RODRIGUEZ, LISSET , MD
PARHIZGAR, ALIREZA , MD
PARIKH, ARCHANA ARPIT, MD
7/15/2011
2/6/2009
1/2/2012
N7322
PARIKH, DIPEN SUBHASH, MD
8/2/2010
P5221
P1913
PARIKH, GAURAV, MD
PARIKH, MAMTA HARISH, MD
1/4/2013
1/17/2012
N8965
P6885
2/5/2010
8/2/2015 NEPHROLOGY
GYNECOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
N/A
2/5/2010 None
N/A
9/8/2008 None
N/A
11/4/2011 None
N/A
2/8/2013 None
N/A
10/26/2010 None
5/15/2009 None
N/A
N/A
6/4/2010 None
N/A
2/5/2010 None
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
ACTIVE
5/7/2009 None
6/29/2012 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
5/11/2012 None
11/20/2012 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
3/14/2011 None
6/5/2013 None
N/A
N/A
TX
ACTIVE
8/5/2011 None
N/A
8/24/2011 None
3/11/2009 None
1/9/2012 None
N/A
N/A
N/A
8/2/2010 None
N/A
1/4/2013 None
1/23/2012 None
N/A
N/A
BAKERSFIELD CA
INTERNAL MEDICINE
HOUSTON
TX
LUBBOCK
TX
INTERNAL MEDICINE
INFECTIOUS
DISEASES
EL PASO
LONGVIEW
WICHITA
FALLS
HOSPITALIST
PLANO
INTERNAL MEDICINE
Page 207 of 300
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Status Date
6/4/2010 None
SAN ANTONIO TX
PLANO
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N6560
N8438
PARIKH, RAKESH, MD
PARIKH, SACHIN RAJENDRA, MD
6/4/2010
1/3/2011
P2504
PARISH, DAVID, MD
3/15/2012
N3228
PARK, CLINTON SANGKYU, MD
5/29/2009
N6561
P3562
P6056
PARK, JASON YOUNG, MD
PARK, JUNG HYUN, MD
PARK, NAM HOON , MD
N9479
PARKER, ASHLEY NICOLE, MD
4/15/2011
N7737
PARKER, CLEVIS TYRONE SR, MD
9/15/2010
P0652
PARKER, DAINA WYATT, MD
8/1/2011
N8235
PARKER, JOHN ROBERT, MD
12/1/2010
P0776
PARKER-ACTLIS, TOMASINA Q, MD
8/15/2011
6/4/2010
6/8/2012
4/1/2013
P7017
N8439
PARKS, THOMAS JOSEPH, MD
PARLOW, SUSAN, MD
6/14/2013
1/3/2011
P5702
PARMET, PHILLIP NOAH, MD
3/1/2013
N8440
PARRA, THELMA GAYTAN, MD
1/3/2011
N7156
PARRELLA, MARK STEPHEN, MD
P2753
PARROTT, JUSTIN JAMES, MD
4/2/2012
L1690
2/5/2010
N5933
PARSA, MICHAEL DARIUS, MD
PARSCHAUER, JUSTIN KENNETH,
DO
N2233
N3232
PARSONS, ALDEN MAIER, MD
PARTAP, ANU NITA, MD
7/15/2010
4/9/2010
2/6/2009
5/29/2009
1/3/2016 RADIOLOGY
Secondary Specialty
(Self-Designated)
BREAST IMAGING
3/15/2017 RADIOLOGY
RADIATION
5/29/2014 ONCOLOGY
6/4/2015 PATHOLOGY
OBSTETRICS AND
EMERGENCY
8/1/2016 MEDICINE
OBSTETRICS AND
PHYSICAL MED. &
1/3/2016 PEDIATRICS
DIAGNOSTIC
3/1/2018 RADIOLOGY
1/3/2016 PEDIATRICS
ORTHOPEDIC
7/15/2015 SURGERY
CHILD AND
ADOLESCENT
4/2/2017 PSYCHIATRY
EMERGENCY
2/5/2015 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
6/4/2010 None
2/15/2011 None
N/A
N/A
3/15/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/16/2009 None
N/A
6/4/2010 None
6/28/2012 None
4/8/2013 None
N/A
N/A
N/A
SAN ANTONIO TX
ACTIVE
4/21/2011 None
N/A
BIG LAKE
TX
ACTIVE
9/22/2010 None
N/A
HOUSTON
TX
ACTIVE
8/5/2011 None
N/A
COLUMBUS
OH
ACTIVE
LICENSE
ISSUED
12/6/2010 None
N/A
8/15/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
6/20/2013 None
1/6/2011 None
N/A
N/A
3/1/2013 None
N/A
1/3/2011 None
N/A
7/15/2010 None
N/A
4/10/2012 None
N/A
CA
ACTIVE
TEXAS
LICENSE
ISSUED
2/5/2010 None
N/A
TX
ACTIVE
5/3/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
2/19/2009 None
6/16/2009 None
N/A
N/A
DALLAS
FORT WORTH TX
DALLAS
HOUSTON
LACONIA
MATERNAL AND
FETAL MEDICINE
PALLIATIVE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
ELECTRODIAGNOSTI
C MEDICINE
ADDISON
DALLAS
PSYCHIATRY
ABILENE
OPHTHALMOLOGY
SANTA
BARBARA
CORPUS
CHRISTI
2/6/2014 THORACIC SURGERY GENERAL SURGERY HOUSTON
DALLAS
Page 208 of 300
TX
TX
NH
TX
TX
TX
License
Number
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
GASTROENTEROLOG
11/15/2010
11/15/2015 Y
INTERNAL MEDICINE
URGENT CARE 7/15/2011
FAMILY PRACTICE
8/15/2013
PSYCHOSOMATIC
10/15/2012
MEDICINE
EMERGENCY
4/12/2013
4/12/2018 MEDICINE
12/15/2010
N8135
Physician Name
PARUPUDI, SREERAM VENKATA
JAGANNADHA, MD
P0464
P7687
PARVATANENI, SIRISHA, MD
PASHAEI, HAMED, MD
P4689
PASOL, ELIAS KIREL, MD
P6239
N8334
PASSANANTE, JOSEPH A, MD
PASSI, KAPIL, MD
N3974
PATAKOTI, RAMU, MD
8/21/2009
N1044
PATALAY, MADHU KUMAR, MD
8/29/2008
P7180
P4496
PATEL, AFSHEEN ABDULLAH, MD
PATEL, AKASH MAHENDRA, MD
7/1/2013
9/17/2012
N8832
2/15/2011
P0465
PATEL, ALPESH ISHVERLAL, MD
PATEL, AMITKUMAR NATVARLAL,
MD
7/15/2011
N1046
PATEL, ANKIT ARVINDBHAI, MD
8/29/2008
P7181
PATEL, BIMAL RAMAN, DO
7/1/2013
P6057
PATEL, DEVANG JITENDRA, MD
4/1/2013
P5298
PATEL, HENNA, DO
1/15/2013
P1009
N7649
P7182
N6952
P5703
P7327
PATEL, KALPESH KANU, MD
PATEL, KALPESH P, MD
PATEL, KAUSHAL , MD
PATEL, KETUL RAJANIKANT, MD
PATEL, KIRTAN S, MD
PATEL, LAJJA JITENDRA, MD
9/15/2011
9/1/2010
7/1/2013
7/1/2010
3/1/2013
7/15/2013
OBSTETRICS AND
7/1/2018 GYNECOLOGY
EMERGENCY
4/1/2018 MEDICINE
PEDIATRIC
GASTROENTEROLOG
1/15/2018 Y
GASTROENTEROLOG
9/15/2016 Y
N7473
PATEL, MALINI , MD
8/16/2010
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
GALVESTON
TX
ACTIVE
12/13/2010 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
8/1/2011 None
8/29/2013 None
N/A
N/A
HARLINGEN
TX
ACTIVE
10/24/2012 None
N/A
AUSTIN
TX
ACTIVE
ACTIVE
DELINQUEN
T-NON
PAYMENT
4/23/2013 None
12/27/2010 None
N/A
N/A
11/19/2009 None
N/A
WICHITA
FALLS
TX
ACTIVE
9/24/2008 None
N/A
COLUMBIA
MO
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/15/2013 None
9/19/2012 None
N/A
N/A
2/15/2011 None
N/A
7/15/2011 None
N/A
NC
ACTIVE
9/18/2008 None
N/A
FORT WORTH TX
ACTIVE
7/15/2013 None
N/A
DALLAS
TX
ACTIVE
4/4/2013 None
N/A
ARLINGTON
TX
ACTIVE
1/23/2013 None
N/A
TX
HOUSTON
HOSPITALIST
DALLAS
HOSPITALIST
INTERNAL MEDICINE FRANKFORT
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
9/22/2011
9/21/2010
7/2/2013
7/7/2010
3/11/2013
7/16/2013
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
8/16/2010 None
N/A
INTERNAL MEDICINE
CARDIOVASCULAR
IMAGING
CHAPEL HILL
PEDIATRICS
Page 209 of 300
KY
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5869
PATEL, MANISHA NILESH, MD
P0268
PATEL, MEHUL DILIP, MD
7/1/2011
P2330
PATEL, MEHUL KIRIT, MD
3/1/2012
P0112
PATEL, NAMRATA MAHENDRA, MD
6/15/2011
7/1/2016 PEDIATRICS
RADIATION
3/1/2017 ONCOLOGY
EMERGENCY
6/15/2016 MEDICINE
P5299
PATEL, NAYANKUMAR, MD
1/15/2013
N9397
PATEL, NEEPA JAYANT, MD
4/8/2011
P5559
2/8/2013
P0466
PATEL, NILESH ARVINDBHAI, MD
PATEL, PARISHRAM
BIPINCHANDRA, MD
7/15/2011
P2506
PATEL, PAYAL VINOD, DO
3/15/2012
P6496
PATEL, PIKUL, MD
P1577
PATEL, POOJA RANI, MD
EMERGENCY
5/1/2018 MEDICINE
OBSTETRICS AND
N1049
PATEL, RAJESH , MD
P2754
PATEL, RAKHI MAGANLAL, MD
3/15/2013
5/1/2013
12/1/2011
PEDIATRICS,
CARDIOLOGY
4/8/2016 NEUROLOGY
HEMATOLOGY/ONCOL
2/8/2018 OGY
ORTHOPEDIC
7/1/2015 TRAUMA
EMERGENCY
8/15/2018 MEDICINE
7/1/2010
9/17/2012
7/15/2011
3/1/2012
P7688
PATEL, SHALU SHARAD, MD
8/15/2013
N6568
P2050
PATEL, SHAMIL SURENDRA, MD
PATEL, SHEETAL B, MD
6/4/2010
2/1/2012
2/1/2017 NEPHROLOGY
P7832
PATEL, SHITEL DINESHBHAI, MD
8/30/2013
N/A
7/11/2011 None
N/A
TEMPLE
TX
ACTIVE
3/7/2012 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
6/20/2011 None
N/A
1/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/18/2011 None
N/A
2/8/2013 None
N/A
7/15/2011 None
N/A
ACTIVE
3/19/2012 None
N/A
ACTIVE
5/3/2013 None
N/A
ACTIVE
1/2/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
10/30/2008 None
N/A
4/2/2012 None
N/A
None
None
None
None
N/A
N/A
N/A
N/A
9/4/2013 None
N/A
IL
ACTIVE
LICENSE
ISSUED
ACTIVE
6/4/2010 None
2/6/2012 None
N/A
N/A
TX
ACTIVE
9/3/2013 None
N/A
FT. BLISS
IL
TX
ORTHOPEDIC
SURGERY
GALVESTON
MIDLAND
INTERNAL MEDICINE CHICAGO
PLASTIC &
RECONSTRUCTIVE
SURGERY
HOUSTON
Page 210 of 300
3/15/2013 None
ACTIVE
OAK LAWN
4/2/2012
Disciplinary
Status Date
TX
INTERNAL MEDICINE
MOVEMENT
DISORDERS
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
INTERNAL MEDICINE
MOHS
MICROGRAPHIC
SURGERY
MORRISTOWN NJ
PATEL, SAILA, DO
PATEL, SAMIR KAUSHIK, MD
PATEL, SANJAY H, DO
PATEL, SEEMA VINOD, MD
Practice City
8/29/2008
N6955
P4497
P0468
P2333
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
TX
7/1/2010
9/26/2012
7/21/2011
3/15/2012
License
Number
Physician Name
P7689
PATEL, SHRESTHA DILIPBHAI, DO
P1207
PATEL, SIMA BALUBHAI, MD
N7325
PATEL, SUKETU, DO
PATEL, TEJAS
PURUSHOTTAMBHAI, MD
PATEL, VISHAL CHANDRAKANT,
MD
PATEL, VIVEK AMRAT, MD
N7159
P5705
N2720
dicaid
dicaid
Agreement
End Date
Designated)
8/15/2013
10/17/2011
8/2/2010
8/2/2015 PATHOLOGY
7/15/2010
3/1/2013
4/3/2009
N7475
PATEL, VIVEK, MD
8/16/2010
P6497
P2334
P1011
N7326
PATEL, ZUHAIB, DO
PATERNINA, JESUS DAVID, MD
PATHAK, INDU S, MD
PATHAK, LAKSHMI KANT, MD
5/1/2013
3/1/2012
9/15/2011
8/2/2010
J4425
PATHAN, ASAD Z, MD
N1051
P7328
P0270
PATHI, SUJATHA , MD
PATIL, PUNAM MAHENDRA, MD
PATIL, SACHIN MALLANAGOUDA,
MD
P7183
PATIL, SACHIN SHYAM, MD
P1127
PATIL, SHASHIKANT, MD
10/3/2011
P0114
PATINO, GILBERTO , MD
6/15/2011
P5870
PATNI, NIVEDITA , MD
3/15/2013
N4655
P0115
PATRICK, CASEY BROCK, MD
PATRINELY, PATRICIA HALL, DO
11/6/2009
6/15/2011
4/1/2013
8/29/2008
7/15/2013
7/1/2011
7/1/2013
EMERGENCY
5/1/2018 MEDICINE
CARDIOVASCULAR
4/1/2018 DISEASES
OBSTETRICS &
GYNECOLOGICAL
8/29/2013 SURGERY
RADIATION
7/1/2018 ONCOLOGY
NEUROLOGICAL
10/3/2016 SURGERY
INTERVENTIONAL
EMERGENCY
11/6/2014 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
GENERAL PRACTICE GALVESTON
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
HOUSTON
DERMATOPATHOLO
GY
FRISCO
THORACIC
CARDIOVASCULAR
SURGERY
INTERVENTIONAL
CARDIOLOGY
Registration
Status of
Practice
Texas
State
License
ACTIVE
8/23/2013 None
N/A
TX
ACTIVE
11/3/2011 None
N/A
TX
ACTIVE
8/23/2010 None
N/A
SAN ANTONIO TX
ACTIVE
7/26/2010 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
3/4/2013 None
4/13/2009 None
N/A
N/A
TYLER
TX
ACTIVE
8/23/2010 None
N/A
DALLAS
MCALLEN
EL PASO
DALLAS
TX
TX
TX
TX
5/10/2013
3/28/2012
9/21/2011
8/5/2010
None
None
None
None
N/A
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
4/1/2013 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
9/24/2008 None
7/23/2013 None
N/A
N/A
ACTIVE
7/8/2011 None
N/A
ACTIVE
7/15/2013 None
N/A
10/17/2011 None
N/A
6/15/2011 None
N/A
TX
SHREVEPORT LA
INTERNAL MEDICINE
PEDIATRIC
ENDOCRINOLOGY
MIAMI
Page 211 of 300
Disciplinary
Status Date
TX
HOUSTON
FAMILY MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
CONROE
ACTIVE
LICENSE
ISSUED
FL
ACTIVE
4/23/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
11/17/2009 None
6/20/2011 None
N/A
N/A
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
ALLERGY AND
P5447
PATTANAIK, DEBENDRA NATH, MD
2/1/2013
2/1/2018 IMMUNOLOGY
RHEUMATOLOGY
AEROSPACE
P6887
PATTARINI, JAMES MARTIN, MD
6/3/2013
N6958
PATTERSON, JOHN , MD
7/1/2010
ORTHOPEDIC
N8834
PATTERSON, RYAN WILLIAM, MD
2/15/2011
2/15/2016 SURGERY
SURGERY
PAULLUS, WAYNE CLIFFORD III,
NEUROLOGICAL
N9277
MD
4/1/2011
4/1/2016 SURGERY
N1053
PAWAR, SANJEEV MADHAV, MD
8/29/2008
N6572
PAWELEK, OLGA , MD
6/4/2010
P5448
PAYAN, HECTOR A, MD
2/1/2013
N3985
PAYNE, JOSHUA RUSH, MD
8/21/2009
P3219
PAYNE, THOMAS, MD
5/15/2012
N6959
PAZ, JUAN ENRIQUE, MD
PEACOCK, WILLIAM FRANKLIN IV,
MD
N5328
7/1/2010
2/5/2010
P0922
P1579
PEARCE, STEVEN GABRIEL, MD
PEARLMAN, MICHAEL L, MD
9/1/2011
12/1/2011
P7533
PEARSON, BRADLEY VANN, MD
8/1/2013
P0271
PEARSON, MATTHEW DEAN, MD
7/1/2011
P2336
PEARSON, NADIA MARY, DO
3/1/2012
P5706
PECK, MARIANNE BERGQUIST, MD
P5120
P5120
P5120
PECKHAM, RUSSELL , DO
3/1/2013
12/17/2012
12/17/2012
12/17/2012
PULMONARY
CRITICAL CARE
2/1/2018 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
OBSTETRICS &
GYNECOLOGICAL
5/15/2017 SURGERY
EMERGENCY
7/1/2015 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
EMERGENCY
8/1/2018 MEDICINE
7/1/2016 UROLOGY
EMERGENCY
3/1/2017 MEDICINE
OBSTETRICS AND
3/1/2018 GYNECOLOGY
Practice City
GALVESTON
EL PASO
PALESTINE,
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
TX
TX
URGENT CARE
MEDICINE
TEMPLE
TX
AUSTIN
GASTROENTEROLOG
Y
HOUSTON
NEURO-ONCOLOGY HOUSTON
UROLOGIC SURGERY AUSTIN
TX
TX
TX
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
FT. HOOD
FT. HOOD
Page 212 of 300
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/1/2013 None
N/A
6/11/2013 None
7/22/2010 None
N/A
N/A
2/15/2011 None
N/A
4/1/2011 None
9/18/2008 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
2/22/2013 None
N/A
ACTIVE
8/27/2009 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/17/2012 None
N/A
7/1/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/23/2011 None
12/7/2011 None
N/A
N/A
8/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
7/12/2011 None
N/A
3/1/2012 None
N/A
3/1/2013 None
N/A
12/17/2012 None
1/17/2013 None
1/17/2013 None
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
License
Number
Physician Name
P1580
PEDROSA, IVAN, MD
N3987
PEEL, GARRETT KEITH, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
12/1/2011
12/1/2016 RADIOLOGY
BODY IMAGING
8/21/2009
N7160
PEINADO FRAGOSO, JESUS, MD
P5223
L8885
PEKAREV, MAXIM, MD
PELLICIA-RAMOS, LUIS ANTONIO,
MD
8/21/2009
N1058
PENA LOPEZ, OMAR JOSE, MD
8/29/2008
N2727
PENA, ALICE MERCEDES, MD
N1057
PENA, ANTONIO , MD
N7650
PENA, ENRIQUE BOSCO, MD
9/1/2010
N9930
PENCE, BENJAMIN TIM, DO
6/3/2011
H8318
N1833
N9764
PENDERGRASS, MERRI LOU , MD
PENG, FANGYU , MD
PENG, LAN , MD
PENGETNZE, YOLANDE
MFONDOUM, MD
N1059
P7534
7/15/2010
1/4/2013
4/3/2009
8/29/2008
12/12/2008
12/12/2008
5/16/2011
8/29/2008
EMERGENCY
8/21/2014 MEDICINE
PHYSICAL MED. &
PAIN
MANAGEMENT/REHAB
6/3/2016 MED
ENDOCRINOLOGY,
DIABETES AND
5/16/2016 PATHOLOGY
8/2/2010
7/1/2013
N8335
PERES, NATANA NAVARRO, MD
PEREZ POVIS, LORENA DEL
MILAGRO, MD
12/15/2010
EMERGENCY
7/1/2018 MEDICINE
INFECTIOUS
12/15/2015 DISEASES
P7535
PEREZ RODRIGUEZ, OMAR, MD
8/1/2013
OBSTETRICS AND
8/1/2018 GYNECOLOGY
P6888
PEREZ, ANGEL S, MD
6/3/2013
6/3/2018 NEUROLOGY
P7184
1/9/2013 None
N/A
TX
ACTIVE
9/2/2009 None
N/A
TX
ACTIVE
9/5/2008 None
N/A
AUSTIN
TX
NACOGDOCH
ES
TX
ACTIVE
4/9/2009 None
N/A
ACTIVE
9/10/2008 None
N/A
AUSTIN
ACTIVE
10/5/2010 None
N/A
6/3/2011 None
N/A
TX
LICENSE
ISSUED
DALLAS
TX
WORCESTER MA
ACTIVE
ACTIVE
ACTIVE
2/9/2009 None
12/18/2008 None
5/25/2011 None
N/A
N/A
N/A
N/A
DALLAS
TX
ACTIVE
REFUGIO
TX
ACTIVE
11/10/2008 None
UNDER
BOARD
8/7/2013 ORDER
HOUSTON
TX
ACTIVE
8/4/2010 None
N/A
HOUSTON
TX
ACTIVE
7/9/2013 None
N/A
OBSTETRICS &
GYNECOLOGICAL
SURGERY
LAREDO
TX
ACTIVE
1/18/2011 None
N/A
ACTIVE
8/5/2013 None
N/A
FAYETTEVILLE AR
ACTIVE
6/21/2013 None
N/A
ACTIVE
SPINAL CORD
INJURY MEDICINE
8/1/2013
N/A
LAREDO
ELSA,
HIDALGO
COUNTY
SPINE MEDICINE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/22/2011 None
N/A
8/27/2009 None
N/A
7/15/2010 None
GENERAL SURGERY
EMERGENCY
4/3/2014 MEDICINE
PENNINGTON, BRENT LEE, MD
PERDON, MICHAEL ARDEN
GOMEZ, MD
N5331
Practice City
DALLAS
BEAUMONT
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
Page 213 of 300
7/1/2013
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6500
P1385
PEREZ, KARLA ALEJANDRA, MD
PERIANAYAGAM, ANJANA, MD
5/1/2013
11/4/2011
P3058
PERKINS, FREEDOM FREDERICK
JR, MD
5/1/2012
N5332
P0272
PERO, ROXANNE ELIZABETH, MD
PERROTTE, NICOLE TAHIRA, MD
2/5/2010
7/1/2011
PEDIATRIC
5/1/2017 NEUROLOGY
OBSTETRICS &
GYNECOLOGICAL
2/5/2015 SURGERY
N6578
PERSON, CHERYL LYNN, MD
6/4/2010
6/4/2015 PSYCHIATRY
P4901
PERSON, MARJORIE , MD
11/15/2012
G3685
N3991
PESICKA, GARY ALLEN, MD
PETERS, DARRELL WAYNE , DO
4/12/2013
8/21/2009
N7571
PETERSON, CHRISTY, MD
8/27/2010
N4663
11/6/2009
N4664
PETERSON, KYLE DAVID, MD
PETERSON, RICHARD MATTHEW ,
MD
EMERGENCY
11/6/2014 MEDICINE
N7651
PETRESCU, MATEI STEFAN, MD
9/1/2010
P5449
PETTIGREW, CANDACE DIANE, MD
2/1/2013
N6579
PETTY, JOSEPH L, MD
6/4/2010
P6242
PETTY, LEONORA KATHLEEN, MD
4/12/2013
P3222
PEZZULLO, ROSEMARIE ANNE, MD
5/15/2012
11/6/2009
Secondary Specialty
(Self-Designated)
P7018
PFANNENSTIEL, TRAVIS JOHN, MD
6/14/2013
N6580
P6243
PFLUKE, JASON MICHAEL, MD
PHAM, ANTOINE NGUYEN, DO
6/4/2010
4/12/2013
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
Practice City
CORPUS
OBSTETRICS
CHRISTI
TX
TX
ACTIVE
ACTIVE
5/13/2013 None
11/22/2011 None
N/A
N/A
CLINICAL
NEUROPHYSIOLOGY AUSTIN
TX
ACTIVE
5/18/2012 None
N/A
2/5/2010 None
8/1/2011 None
N/A
N/A
6/4/2010 None
N/A
11/15/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/18/2013 None
10/5/2009 None
N/A
N/A
8/27/2010 None
N/A
TX
ACTIVE
1/27/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
11/16/2009 None
N/A
9/1/2010 None
N/A
2/1/2013 None
N/A
6/4/2010 None
N/A
ACTIVE
4/23/2013 None
N/A
ACTIVE
5/21/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/24/2013 None
N/A
6/4/2010 None
4/25/2013 None
N/A
N/A
HOSPITALIST
ATLANTA
OPHTHALMOLOGY VITREOUS SURGERY DALLAS
EL PASO
PEDIATRIC INTENSIVE
9/1/2015 CARE
PEDIATRICS
EMERGENCY
2/1/2018 MEDICINE
OBSTETRICS AND
6/4/2015 GYNECOLOGY
CHILD AND
ADOLESCENT
PSYCHIATRY
OTOLARYNGOLOGY
6/14/2018 (NEUROTOLOGY)
Registration
Status of
Practice
Texas
State
License
BEAUMONT
LACKLAND
AFB
EL PASO
FORT SAM
HOUSTON
OTOLARYNGOLOGY
Page 214 of 300
GA
TX
TX
TX
TX
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
N4666
PHAM, CYNTHIA ANNE, DO
11/6/2009
FAMILY
PRACTICE/OMM
N3993
P0924
PHAM, DUNG QUOC, MD
PHAM, MARY ELIZABETH , MD
8/21/2009
9/1/2011
8/21/2014 UROLOGY
UROLOGIC SURGERY
FAMILY MEDICINE
AMARILLO
P2756
PHAM, NIKKI HOA THI, MD
P6245
P1128
PHAM, QUOC VAN, MD
PHAM, RYAN KHANHHOANG, DO
P3060
PHAM, SON VAN, MD
5/1/2012
P2757
PHAM, TRUC THI THU, MD
4/2/2012
4/2/2012
4/12/2013
10/3/2011
EMERGENCY
4/12/2018 MEDICINE
INTERVENTIONAL
5/1/2017 CARDIOLOGY
CARDIOVASCULAR
DISEASES
2/8/2013
N6962
PHAM-HILL, TRAM BAO, MD
7/1/2010
P7834
PHAN, AN T, MD
8/30/2013
N5943
P2340
P4995
P1208
P3565
PHAN, CECILE L., MD
PHAN, DUC HONG, MD
PHAN, NGOC KHANH THI, DO
PHATAK, UMA R, MD
PHILIP, LEENA, MD
NEUROMUSCULAR
4/9/2015 DISEASE
P1129
PHILIPS, SHAILE, MD
N5944
P5876
PHILLIPS, BRANDON LANE, MD
PHILLIPS, CHRISTOPHER WEST,
MD
N9765
N1836
PHILLIPS, JACQUELINE MARIE, DO
PHILLIPS, JAN ELIZABETH, MD
P6061
PHILLIPS, JUSTIN DANIEL, MD
4/1/2013
EMERGENCY
4/1/2018 MEDICINE
P5707
PHILLIPS, MARGARET ELIZABETH,
MD
3/1/2013
4/9/2010
3/15/2013
5/16/2011
12/12/2008
TX
SAN ANTONIO TX
PHAM, VIET HOAI, MD
10/3/2011
MI
FORT WORTH TX
P5560
4/9/2010
3/1/2012
11/30/2012
10/17/2011
6/8/2012
EASTPOINTE
Registration
Status of
Practice
Texas
State
License
OTORHINOLARYNGO
LOGY
GALVESTON
NEUROLOGY
HOSPITALIST
ABDOMINAL
RADIOLOGY
10/3/2016 RADIOLOGY
PEDIATRICS,
4/9/2015 CARDIOLOGY
EMERGENCY
3/15/2018 MEDICINE
PEDIATRICS
URGENT CARE
MEDICINE
HOUSTON
HOUSTON
HOUSTON
HOUSTON
TX
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
11/18/2009 ORDER
11/9/2009
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
10/26/2009 None
12/9/2011 None
N/A
N/A
4/2/2012 None
N/A
4/12/2013 None
10/4/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
5/3/2012 None
N/A
4/2/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/20/2013 None
N/A
7/1/2010 None
N/A
8/30/2013 None
N/A
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/26/2010
3/15/2012
12/4/2012
10/19/2011
6/12/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
SAN ANTONIO TX
ACTIVE
10/11/2011 None
N/A
SAN ANTONIO TX
ACTIVE
4/14/2010 None
N/A
ACTIVE
3/29/2013 None
N/A
ACTIVE
ACTIVE
6/9/2011 None
2/12/2009 None
N/A
N/A
ACTIVE
4/5/2013 None
N/A
ACTIVE
3/18/2013 None
N/A
DALLAS
Page 215 of 300
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
DIAGNOSTIC
8/29/2008
8/29/2013 RADIOLOGY
BREAST IMAGING
N1068
PHILLIPS, STEPHEN WAYNE, MD
N6582
P1387
PHILLIPS, TIMOTHY MARTIN, MD
PHUAH, ELAINE IE LIN, DO
N8443
PHUNG, TRI MINH, MD
1/3/2011
N2732
PHUNG, VU , MD
4/3/2009
P1482
P7538
N9932
PICKNEY, LUCILLE MARY, MD
PIDLAOAN, VICTORIO PARAYNO,
MD
PIERCE, BROCK LAWSON, MD
P2341
PIERI, RICHARD EMEKA, MD
3/1/2012
P3223
PIERRE, HAROLD LUCO, MD
5/15/2012
P0469
PIERRE, JAMES ANTHONY JR, MD
7/15/2011
N9279
PIERRE, ZENITHE C, MD
4/1/2011
P2342
PIERSON, SERENA MICHELLE, MD
3/1/2012
N9280
PILIKA, ASTI PAVLLO, MD
4/1/2011
P2343
N8236
N4670
3/1/2012
12/1/2010
11/6/2009
P3566
P0470
PILLAI, REGINA , MD
PILLAI, SANGEETHA R, MD
PILLAI, SUJESH SATHYAN , MD
PILLI, PRASAD JOHNSON RAJU,
MD
PILLI, SUJA PERAKATHU, MD
P5709
P1915
PILLUS, DAVID, MD
PIMENTEL, SACRAMENTO, MD
3/1/2013
1/17/2012
EMERGENCY
3/1/2018 MEDICINE
N8836
PIMPALWAR, ASHWIN , MD
2/15/2011
6/4/2010
11/4/2011
11/15/2011
8/1/2013
6/3/2011
6/8/2012
7/15/2011
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
ACTIVE
9/9/2008 None
N/A
6/4/2010 None
11/8/2011 None
N/A
N/A
TX
ACTIVE
1/21/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
5/18/2009 None
N/A
11/15/2011 None
N/A
ACTIVE
ACTIVE
8/13/2013 None
6/16/2011 None
N/A
N/A
3/26/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/15/2012 None
N/A
ACTIVE
7/21/2011 None
N/A
6/4/2015 PEDIATRIC UROLOGY UROLOGIC SURGERY
CRITICAL CARE
ANESTHESIOLOGY
DALLAS
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
HOUSTON
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
6/3/2016 OBSTETRICS
INFECTIOUS
3/1/2017 DISEASES
DALLAS
INTERNAL MEDICINE
OBSTETRICS AND
3/1/2017 GYNECOLOGY
4/1/2016 RADIOLOGY
PULMONARY
CRITICAL CARE
3/1/2017 MEDICINE
TX
HOUSTON
TX
ACTIVE
4/11/2011 None
N/A
DALLAS
TX
ACTIVE
4/16/2012 None
N/A
EDEN PRAIRIE MN
ACTIVE
4/12/2011 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
3/8/2012 None
12/7/2010 None
11/24/2009 None
N/A
N/A
N/A
HARLINGEN
HARLINGEN
TX
TX
ACTIVE
ACTIVE
6/11/2012 None
7/20/2011 None
N/A
N/A
BURLINGTON
CO
ACTIVE
ACTIVE
LICENSE
ISSUED
3/7/2013 None
1/26/2012 None
N/A
N/A
2/15/2011 None
N/A
HOUSTON
HOSPITALIST
HUNTSVILLE
Page 216 of 300
License
Number
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
INTERVENTIONAL
11/15/2010
RADIOLOGY
2/4/2011
N8137
N8706
Physician Name
PIMPALWAR, SHEENA ASHWIN,
MD
PIMSLEUR, MARC , MD
N3995
N2246
P7691
PINCKNEY, JAMES SAMUEL II, MD
PINE, HAROLD SCOTT, MD
PINNAMANENI, PAVAN , MD
N6964
PINNINTI, USHA, MD
N8138
PINNIX, CHELSEA CAMILLE, MD
N6583
N4671
P4799
PINNOW, JEFFERY MATTHEW, MD
PINO, JONATHAN WILLIAM, MD
PINTO, MAURICIO , MD
6/4/2010
11/6/2009
11/1/2012
P7539
N4673
PIPARIA, MAANSI, MD
PIRRAGLIA, PETER DOMINIC, MD
8/1/2013
11/6/2009
N9933
PITINO, LISA MARIE MORAWSKI,
DO
P2508
8/21/2009
2/6/2009
8/15/2013
7/1/2010
11/15/2010
6/3/2011
N2248
PITOTTI, CHRISTOPHER , MD
PITTMAN, LAURA MARGUERITE,
MD
3/15/2012
3/15/2017
2/6/2009
2/6/2014
P6890
P0653
PIWONKA, KYLE THOMAS, DO
PIZZOLA, STEPHAN G, MD
6/3/2013
8/1/2011
6/3/2018
8/1/2016
P7540
PLOSKANYCH, TARAS , MD
8/1/2013
8/1/2018
P2758
PLOTKIN, FREDRIC ROBERT, MD
4/2/2012
4/2/2017
N9114
P1680
P6248
PODOLSKI, JOSEPH EDWARD, DO
POGOSIAN, ELENA GRIGOREVNA,
MD
POKHAREL, YASHASHWI, MD
P7330
POLES, JOSH , DO
3/15/2011
12/15/2011
4/12/2013
7/15/2013
HOUSTON
HARLINGEN
12/8/2010 None
2/14/2011 None
N/A
N/A
GALVESTON TX
HUNTINGTON TX
ACTIVE
ACTIVE
ACTIVE
9/29/2009 None
3/26/2009 None
8/20/2013 None
N/A
N/A
N/A
TX
ACTIVE
7/5/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
11/18/2010 None
N/A
6/4/2010 None
11/13/2009 None
11/12/2012 None
N/A
N/A
N/A
ACTIVE
ACTIVE
8/2/2013 None
11/24/2009 None
N/A
N/A
6/3/2011 None
N/A
AUSTIN
ISLAND PARK
EMERGENCY
7/15/2018 MEDICINE
Disciplinary
Status Date
ACTIVE
ACTIVE
EMERGENCY
MEDICAL SERVICES
HENRIETTA
HOSPITALIST
PHYSICAL MED. &
REHABILITATION
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
ANESTHESIOLOGY
PHYSICAL MED. &
REHABILITATION
EMERGENCY
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
OPHTHALMOLOGY VITREOUS SURGERY HOUSTON
RADIATION
11/15/2015 ONCOLOGY
EMERGENCY
6/4/2015 MEDICINE
OBSTETRICS AND
8/1/2018 GYNECOLOGY
6/3/2016
Practice City
Registration
Status of
Practice
Texas
State
License
TX
TX
NY
PAIN
MANAGEMENT/REHA
B MED
LICENSE
ISSUED
FT SAM
HOUSTON
TX
ACTIVE
3/21/2012 None
N/A
AUSTIN
TX
ACTIVE
2/11/2009 None
N/A
MCALLEN
SAN ANGELO
TX
TX
ACTIVE
ACTIVE
6/17/2013 None
8/5/2011 None
N/A
N/A
TEMPLE
TX
ACTIVE
8/5/2013 None
N/A
GENERAL PRACTICE MIAMI
FL
FORENSIC
PSYCHIATRY
PALLIATIVE
MEDICINE
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
4/18/2012 None
N/A
ACTIVE
4/22/2011 None
N/A
ACTIVE
ACTIVE
12/22/2011 None
4/22/2013 None
N/A
N/A
FORT WORTH TX
ACTIVE
8/26/2013 None
N/A
OPHTHALMOLOGY
Page 217 of 300
License
Number
Physician Name
P0654
POLEY, RAINER NIKOLAUS, MD
P6700
P1131
POLKAMPALLY, PRITAM RAO, MD
POLLARD, KATHLEEN ROSE, MD
POLNASZEK, NATHANIEL
MICHAEL, MD
POMEROY, BRIAN JAMES, MD
POMMERENING, MATTHEW
JAMES, MD
P1682
P3061
P4498
P3416
POOLE, KIMBERLY MELISSA, DO
P1918
PORR, JENNIFER REHM, MD
N8707
PORRES AGUILAR, MATEO , MD
P4694
P1211
PORTEN, SIMA PRABODH, MD
PORTER, CHAD THOMAS, MD
N6585
PORTER, EMILY ANN, MD
N2736
PORTER, JOHN WARREN, MD
P4902
N3998
PORTER, JONATHAN CASTILLO,
MD
POSHOGHLIAN, HAGOP , MD
P0655
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
INTERVENTIONAL
DIAGNOSTIC
8/1/2011
8/1/2016 RADIOLOGY
RADIOLOGY
INTERVENTIONAL
5/15/2013
CARDIOLOGY
10/3/2011
12/15/2011
5/1/2012
9/17/2012
6/1/2012
1/17/2012
2/4/2011
10/15/2012
10/17/2011
6/4/2010
4/3/2009
11/15/2012
8/21/2009
N7328
POSS, JAMES MATTHEW, MD
POTAKAMURI, LAKSHMI
NARAYANA, MD
P3225
POTTER, ANDREW , DO
5/15/2012
P7331
POTTER, ELISABETH HOUSE, MD
POURALIFAZEL, POOYA PATRICK,
MD
7/15/2013
P4607
N9400
N7652
POURCIAU, CRYSTAL YVONNE, MD
POWELL, KARLYN, MD
12/15/2016 UROLOGY
5/1/2017 PEDIATRICS
8/1/2011
8/2/2010
EMERGENCY
5/15/2017 MEDICINE
PLASTIC &
RECONSTRUCTIVE
7/15/2018 SURGERY
10/1/2012
4/8/2011
9/1/2010
ACTIVE
8/15/2011 None
N/A
LAKEWAY
TX
ACTIVE
ACTIVE
6/11/2013 None
10/31/2011 None
N/A
N/A
UROLOGIC SURGERY ROUND ROCK TX
LUBBOCK
TX
ACTIVE
ACTIVE
1/2/2012 None
5/15/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
9/24/2012 None
N/A
6/1/2012 None
N/A
1/17/2012 None
N/A
2/4/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
10/24/2012 None
10/31/2011 None
N/A
N/A
6/4/2010 None
N/A
4/10/2009 None
N/A
11/21/2012 None
8/31/2009 None
N/A
N/A
8/1/2011 None
N/A
ACTIVE
8/23/2010 None
N/A
FORENSIC
PSYCHIATRY
HOUSTON
TX
TEMPLE
TX
Disciplinary
Status Date
TX
10/15/2017 UROLOGY
EMERGENCY
6/4/2015 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
AUSTIN
6/1/2017 PSYCHIATRY
Practice City
Registration
Status of
Practice
Texas
State
License
UROLOGIC
ONCOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
PEDIATRICS
PLASTIC SURGERY
HOUSTON
HOUSTON
TX
TX
HOUSTON
TX
ACTIVE
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
6/4/2012 None
N/A
AUSTIN
OKLAHOMA
CITY
TX
ACTIVE
7/24/2013 None
N/A
OK
10/15/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/8/2011 None
9/6/2010 None
N/A
N/A
PEDIATRIC
DERMATOLOGY
Page 218 of 300
License
Number
P0863
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PLASTIC &
RECONSTRUCTIVE
8/26/2011
8/26/2016 SURGERY
N1075
POWERS, KAREN LYNNE, MD
POWERS, MICHELLE LEIGH
EHRLICH, MD
POWITZKY, ROSSER KENNEDY,
MD
PRABHAKAR, BALAKRISHNA
RAJARAM, MD
N7573
PRADERIO, CAROLINA, MD
N5950
PRADHAN, KUMUDA RANJAN, MD
4/9/2010
P1389
PRASARN, MARK LAWRENCE, MD
11/4/2011
N1077
N4679
PRATER, SAMUEL JOSIAH, MD
PREDANIC, ANETA, MD
8/29/2008
11/6/2009
N1839
P5710
12/12/2008
3/1/2013
8/29/2008
8/27/2010
ST. LOUIS
PEDIATRIC
OTOLARYNGOLOGY
OBSTETRICS AND
N4680
N5952
N4000
PREDANIC, MLADEN, MD
PREISBERGA, KRISTA, MD
PRENZLAUER, STEVEN , MD
11/6/2009
4/9/2010
8/21/2009
P0864
N7329
PREVENTZA, OURANIA , MD
PRICE, ERIC WILLIAM, MD
8/26/2011
8/2/2010
P3660
N3252
PRICE, STEPHEN BRYAN, MD
PRIMOMO, JOHN ANTHONY , MD
6/15/2012
5/29/2009
6/15/2017 RADIOLOGY
N8056
PRINCE, AUDRA MCCAY, MD
10/29/2010
P5225
N4682
PROBST, JOSEPH JOHN, MD
PROU, MITCHELL JUIN, MD
1/4/2013
11/6/2009
1/4/2018 RADIOLOGY
P1809
N7330
PROVENCIO, MAURO JR, MD
PRUNA, ERNESTO, MD
1/2/2012
8/2/2010
N7740
PRZYBYLA, JEFFREY ALAN, MD
Practice City
LICENSE
ISSUED
ORTHOPEDIC
SURGERY OF THE
11/4/2016 SPINE
EMERGENCY
8/29/2013 MEDICINE
MATERNAL AND
4/9/2015 PEDIATRICS
THORACIC
CARDIOVASCULAR
8/26/2016 SURGERY
9/15/2010
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
OBSTETRICS AND
GYNECOLOGY
SPORTS MEDICINE
(FAMILY PRACTICE)
TRAUMATIC
Page 219 of 300
8/26/2011 None
N/A
ACTIVE
12/24/2008 None
N/A
MINNEAPOLIS MN
ACTIVE
3/8/2013 None
N/A
SEALY
CORPUS
CHRISTI
TX
ACTIVE
9/23/2008 None
N/A
TX
ACTIVE
LICENSE
ISSUED
9/8/2010 None
N/A
4/9/2010 None
N/A
HOUSTON
TX
ACTIVE
11/16/2011 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
9/22/2008 None
11/11/2009 None
N/A
N/A
DALLAS
TX
CHICAGO
IL
ROUND ROCK TX
ACTIVE
ACTIVE
ACTIVE
11/11/2009 None
4/29/2010 None
8/26/2009 None
N/A
N/A
N/A
LICENSE
ISSUED
ACTIVE
8/26/2011 None
9/16/2010 None
N/A
N/A
ACTIVE
ACTIVE
6/19/2012 None
6/16/2009 None
N/A
N/A
ACTIVE
11/5/2010 None
N/A
CRITICAL CARE
(SURGERY)
INTERVENTIONAL
RADIOLOGY
Disciplinary
Status Date
MO
OTHER SPECIALTY
ORTHOPEDIC
TRAUMA
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANTONIO TX
HOUSTON
TX
FORT SAM
HOUSTON
GALVESTON
TX
TX
ACTIVE
ACTIVE
1/15/2013 None
11/24/2009 None
N/A
N/A
EL PASO
DALLAS
TX
TX
ACTIVE
ACTIVE
1/4/2012 None
8/6/2010 None
N/A
N/A
CONROE
TX
ACTIVE
9/21/2010 None
N/A
License
Number
N1080
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1484
PUCKETT, FREDRIC CLARK, DO
PUDHOTA, SUNITHA GUDAPATI,
MD
8/29/2008
P0276
PUENTE CUELLAR, NAPOLEON
ANTONIO, MD
P7692
PUGAO, REO, MD
N6588
PUIG, CARLOS EDUARDO, MD
P3227
PULLALAREVU, RAGHAVESH, MD
5/15/2012
P7835
P0277
P3228
N7741
PULLANO, JAMES GEORGE, MD
PUNATAR, ANKIT D, MD
PUNJABI BAJPAI, ANITA , DO
PUNNOOSE, JENNIFER , MD
8/30/2013
7/1/2011
5/15/2012
9/15/2010
OBSTETRICS AND
P0118
PURANIK, NIRANJAN , MD
6/15/2011
11/15/2011
7/1/2011
8/15/2013
6/4/2010
GASTROENTEROLOG
11/15/2016 Y
PULMONARY
CRITICAL CARE
7/1/2016 MEDICINE
ORAL &
MAXILLOFACIAL
8/15/2018 SURGERY
OBSTETRICS AND
6/4/2015 GYNECOLOGY
P2510
PURAYIDOM, ANNILYN S, MD
3/15/2012
3/15/2017 PATHOLOGY
N8837
P5878
PURI, RAHUL DINESH, MD
PURYEAR, ANGEL SUN, MD
2/15/2011
3/15/2013
N6589
PUTHOORAN, SONIA A, MD
PUTMAN, CHRISTOPHER MARK,
MD
QAMAR, MUHAMMAD UMAIR RAFI,
MD
QIAN, BAOPING , MD
QIANG, MEI, MD
ENDOCRINOLOGY,
DIABETES AND
6/4/2015 METABOLISM
P2346
N5342
N4006
N4007
P2760
P7020
QIU, CUIE , MD
QUAINE, PATRICIA ANN REYES,
MD
6/4/2010
Disciplinary
Status Date
TX
ACTIVE
10/2/2008 None
N/A
MANSFIELD
TX
ACTIVE
11/24/2011 None
N/A
ORAL &
MAXILLOFACIAL
SURGERY
EL PASO
TX
ACTIVE
7/14/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/21/2013 None
N/A
6/4/2010 None
N/A
6/4/2012 None
N/A
INTERNAL MEDICINE PITTSBURGH
MATERNAL AND
FETAL MEDICINE
SUGAR LAND
DALLAS
PA
ACTIVE
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
RADIOLOGY
DALLAS
TX
PLAINVIEW
HOUSTON
TX
TX
4/2/2017 NEUROLOGY
GASTROENTEROLOG
6/14/2018 Y
INTERNAL MEDICINE TOMBALL
Page 220 of 300
None
None
None
None
N/A
N/A
N/A
N/A
6/15/2011 None
N/A
3/23/2012 None
N/A
2/15/2011 None
3/20/2013 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
4/16/2012 None
N/A
2/5/2010 None
8/26/2009 None
9/7/2009 None
N/A
N/A
N/A
4/2/2012 None
N/A
ACTIVE
6/20/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE
2/5/2010
8/21/2009
8/21/2009
Registration
Status Date
Disciplinary
Status of
Texas
License
ENNIS
PLANO
3/1/2017 NEURO-RADIOLOGY
6/14/2013
Practice City
BLOOD
BANKING/TRANSFUSI
ON MEDICINE
3/1/2012
4/2/2012
Secondary Specialty
(Self-Designated)
FAMILY
PRACTICE/OMM
Registration
Status of
Practice
Texas
State
License
TX
9/5/2013
7/12/2011
5/21/2012
10/18/2010
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
FAMILY
8/1/2011
11/4/2011
P0656
P1390
QUALLS, JAMES ROBERT, DO
QUBTY, ROBIN , DO
N5955
QUIAMBAO, LEONILA SONGCO, MD
4/9/2010
P5711
QUIGG, TROY CHRISTOPHER, DO
3/1/2013
P7545
QUINN, BRENDON MICHAEL, MD
QUINN, COURTNEY ELIZABETH,
MD
QUINN, MELISSA DE JESUS, MD
8/1/2013
P2761
N4011
4/2/2012
8/21/2009
PEDIATRIC
HEMATOLOGY/ONCOL
3/1/2018 OGY
PEDIATRICS
UNDERSEA AND
HYPERBARIC MED
8/1/2018 GENERAL SURGERY (PREV MED)
PHYSICAL MED. &
REHABILITATION
CHILD AND
ADOLESCENT
PSYCHIATRY
FAMILY MEDICINE
INTERNAL MEDICINE
N9116
QUINONES PAGAN, VIRMARIE, MD
3/15/2011
3/15/2016
N7331
N4012
N1085
8/2/2010
8/21/2009
8/29/2008
8/2/2015
8/21/2014
8/29/2013
N9937
QUINTANA, HUMBERTO, MD
QUINTANA, MAX E, MD
QUINTANILLA, ELEAZAR JR, MD
QUINTANILLA-DIECK, MARIA
JOSEFINA, MD
P5712
QUIROZ, RENE, MD
P0865
P3567
QURESHI, ATIF SALEEM, MD
QURESHI, IRFAN RASHID, MD
8/26/2011
6/8/2012
N3255
QURESHI, JAVED , MD
5/29/2009
N3256
QURESHI, MUHAMMAD ASIF, MD
5/29/2009
N6591
N2742
QURESHI, SALAH UDDIN, MD
QURESHI, YOUSUF AMIN, MD
6/4/2010
4/3/2009
N8445
QUYSNER, ANNIE , MD
RAAYASA, SRIKANTH
KRISHNAMURTHY, MD
1/3/2011
6/4/2015 PSYCHIATRY
EMERGENCY
1/3/2016 MEDICINE
7/1/2011
7/1/2016 NEPHROLOGY
P0278
6/3/2011
3/1/2013
Secondary Specialty
(Self-Designated)
CARDIOVASCULAR
3/1/2018 DISEASES
PULMONARY
CRITICAL CARE
8/26/2016 MEDICINE
DIAGNOSTIC
5/29/2014 RADIOLOGY
PEDIATRICS,
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
WACO
TX
ACTIVE
ACTIVE
8/26/2011 None
11/11/2011 None
N/A
N/A
AUSTIN
TX
ACTIVE
4/14/2010 None
N/A
SAN ANTONIO TX
ACTIVE
3/11/2013 None
N/A
PARIS
ACTIVE
LICENSE
ISSUED
ACTIVE
8/15/2013 None
N/A
4/2/2012 None
8/27/2009 None
N/A
N/A
3/15/2011 None
N/A
8/30/2010 None
10/12/2009 None
9/24/2008 None
N/A
N/A
N/A
TX
SAN ANTONIO TX
PEDIATRIC
REHABILITATION
MEDICINE
LICENSE
ISSUED
PSYCHIATRY
AUSTIN
HARLINGEN
TX
TX
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
6/13/2011 None
N/A
MA
ACTIVE
3/15/2013 None
N/A
VICTORIA
TX
LICENSE
ISSUED
ACTIVE
8/26/2011 None
6/12/2012 None
N/A
N/A
VICTORIA
TX
ACTIVE
6/15/2009 None
N/A
AMARILLO
TX
6/11/2009 None
N/A
KATY
CORPUS
CHRISTI
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
6/4/2010 None
4/16/2009 None
N/A
N/A
TX
ACTIVE
1/7/2011 None
N/A
TX
ACTIVE
8/16/2011 None
N/A
VASCULAR MEDICINE BOSTON
SLEEP MEDICINE
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
NEUROPSYCHIATRY
INTERNAL MEDICINE KINGWOOD
Page 221 of 300
License
Number
Physician Name
P7188
RABDIYA, VIMAL, MD
P4696
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
7/1/2013
7/1/2018 CARDIOLOGY
INTERNAL MEDICINE
OBSTETRICS AND
10/15/2012
OBSTETRICS AND
7/1/2010
7/1/2015 GYNECOLOGY
EMERGENCY
5/1/2013
5/1/2018 MEDICINE
HEMATOLOGY 8/21/2009
8/21/2014 ONCOLOGY
INTERNAL MEDICINE
12/12/2008
N6968
RABSATT, LATASHA ALEXIS, MD
RAC, MARTHA WATTINE FRAZIER,
MD
P6504
RACEY, JEREMY CLYDE, MD
N4015
N1842
P7546
RADAIDEH, SOFYAN M., MD
RADHAKRISHNA, PAVANA , MD
RADWANSKI, SYLVIA VICTORIA,
MD
N5956
N7574
RAFATI, DANNY SALAH, MD
RAFEEK, JASMINE, MD
P1683
RAFIE, SHERVIN, MD
N5344
N4016
RAFIQUE, ZUBAID, MD
RAFOLS, RAFAEL JOSE, MD
2/5/2010
8/21/2009
P0472
RAGHUTHAMAN, THARA, MD
7/15/2011
P4998
RAGHUWANSHI, ANITA P, MD
11/30/2012
N4685
RAGO, OSCAR, MD
11/6/2009
P7336
RAHHAL, RYAN FOUAD, MD
7/15/2013
8/1/2013
4/9/2010
8/27/2010
4/9/2015 PEDIATRICS
12/15/2011
N5345
RAHIMI, ABDULWALI SAMAD, MD
2/5/2010
P7837
RAHMAN, ARIF, MD
8/30/2013
P1583
RAHMAN, HASSAN TOUFIQUR, MD
12/1/2011
N7164
RAHMAN, SAIYYEDA , MD
7/15/2010
N1424
RAHNEMA, MOLOUK , MD
10/10/2008
Practice City
URBABA
Registration
Status of
Practice
Texas
State
License
IL
ACTIVE
ENDOCRINOLOGY,
DIABETES AND
EMERGENCY
11/6/2014 MEDICINE
NEUROLOGICAL
7/15/2018 SURGERY
ENDOCRINOLOGY,
DIABETES AND
N/A
ACTIVE
7/23/2010 None
N/A
ACTIVE
5/13/2013 None
N/A
DALLAS
CHICAGO
TX
IL
ACTIVE
ACTIVE
10/5/2009 None
3/10/2009 None
N/A
N/A
8/9/2013 None
N/A
4/9/2010 None
9/10/2010 None
N/A
N/A
12/23/2011 None
N/A
2/5/2010 None
8/31/2009 None
N/A
N/A
ACTIVE
7/21/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
12/4/2012 None
N/A
11/6/2009 None
N/A
7/15/2013 None
N/A
2/5/2010 None
N/A
9/9/2013 None
N/A
12/7/2011 None
N/A
7/15/2010 None
N/A
10/15/2008 None
N/A
HOUSTON
MCALLEN
DALLAS
DIAGNOSTIC
8/30/2018 RADIOLOGY
10/22/2012 None
TX
SAN ANTONIO TX
HOSPITALIST
PEDIATRIC
NEUROLOGY
ACTIVE
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ABDOMINAL
RADIOLOGY
EMERGENCY
2/5/2015 MEDICINE
TX
EMERGENCY
MEDICINE
INTERVENTIONAL
RADIOLOGY
HOUSTON
TX
ACTIVE
OPHTHALMOLOGY
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
FAMILY MEDICINE
Page 222 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
9/2/2013 None
N/A
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N8563
RAI, HAR PRATAP, MD
1/18/2011
1/18/2016 PATHOLOGY
P7693
RAINS, MICHAEL LEROY, MD
8/15/2013
N5958
N7480
RAJA, MANISHA, MD
RAJABI HANJANI, MITRA, MD
4/9/2010
8/16/2010
N1089
N8973
P4698
RAJAGIRIYIL, NANCY CHACKO, DO
RAJAMAHANTY, SRINIVAS, MD
RAJAN, JESSEN ANN, MD
P3661
P4500
RAJAN, NIRAJA, MD
RAJAN, THOMAS, MD
6/15/2012
9/17/2012
RAJANI, RAJIV, MD
RAJAPREYAR, INDRANEE
P7337
NAMASIVAYAM, MD
RAJKOWSKI, SAMUEL THOMAS,
TM00478 DO
5/2/2011
N9624
8/29/2008
3/1/2011
10/15/2012
7/15/2013
10/3/2011
3/1/2016 UROLOGY
MUSCULOSKELETAL
5/2/2016 ONCOLOGY
CARDIOVASCULAR
7/15/2018 DISEASES
10/3/2016 RADIOLOGY
DIAGNOSTIC
6/3/2018 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
GERIATRICS
PAIN MANAGEMENT
FAMILY PRACTICE
CONROE
TX
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
ORTHOPEDIC
SURGERY
HOUSTON
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
1/18/2011 None
N/A
8/15/2013 None
N/A
4/9/2010 None
8/24/2010 None
N/A
N/A
9/5/2008 None
3/21/2011 None
11/19/2012 None
N/A
N/A
N/A
6/15/2012 None
12/7/2012 None
N/A
N/A
5/2/2011 None
N/A
ACTIVE
8/15/2013 None
N/A
MILWAUKEE
WI
FRIENDSWOO
D
TX
ACTIVE
10/18/2011 None
N/A
ACTIVE
6/7/2013 None
N/A
CA
ACTIVE
2/28/2013 None
N/A
NY
ACTIVE
4/22/2013 None
N/A
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
5/16/2011 None
4/16/2013 None
N/A
N/A
6/15/2012 None
N/A
RAJU, ROMAN , MD
6/3/2013
P5451
RAJURKAR, SWAPNIL, MD
2/1/2013
P6249
RALSTON, MELISSA FAITH, MD
4/12/2013
EMERGENCY
4/12/2018 MEDICINE
N9768
P6250
RAMACHANDRAN, KAVAN, MD
RAMACHANDRAN, SHALINI, MD
5/16/2011
4/12/2013
P3662
RAMACHANDRUNI, SRIKANTH, MD
6/15/2012
P6703
5/15/2013
N2748
RAMAKRISHNA, ROHAN, MD
RAMAKRISHNAN,
THIRUVENGADAM , MD
N7862
RAMALINGAM, PREETHA, MD
10/1/2010
P0658
RAMAN, SIVAKUMAR, MD
NEUROLOGICAL
5/15/2018 SURGERY
HOUSTON
GASTROENTEROLOG GASTROENTEROLOG
4/3/2014 Y
Y
GALVESTON
ANATOMIC/CLINICAL
10/1/2015 PATHOLOGY
HOUSTON
INFECTIOUS
8/1/2016 DISEASES
INTERNAL MEDICINE
Page 223 of 300
8/1/2011
ACTIVE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
P6893
4/3/2009
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
NEURO-RADIOLOGY
HEMATOLOGY/ONCO
LOGY
POMONA
EAST
PATCHOGUE
PULMONARY
CRITICAL CARE
MEDICINE
DALLAS
TX
ACTIVE
5/29/2013 None
N/A
TX
ACTIVE
4/13/2009 None
N/A
TX
ACTIVE
10/14/2010 None
N/A
ACTIVE
8/12/2011 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CARDIOVASCULAR
INTERVENTIONAL
4/2/2012
4/2/2017 DISEASES
CARDIOLOGY
P2763
RAMANATH, VIJAY SITHARAM, MD
N8448
N7165
RAMAS, MARIE-ELIZABETH , MD
RAMASAHAYAM, LAKSHMI, MD
P3569
RAMIREDDY, SWEEYA REDDY , MD
6/8/2012
P5562
RAMIREZ, ANDREA ANNE, MD
2/8/2013
P7547
RAMIREZ, CARMEN TERESA, MD
RAMIREZ, DANIEL ALBERTO JR,
MD
8/1/2013
7/15/2013
N7863
RAMIREZ, ELIZABETH ANN, MD
RAMIREZ, JONATHAN CHARLES,
MD
N9940
RAMIREZ, LORIMAR , MD
P0866
RAMIREZ, ORLANDO MANUEL, MD
8/26/2011
N4023
RAMIREZ, STEVE , MD
8/21/2009
N6596
P1685
RAMMAGE, JENNIFER LEIGH, MD
RAMOLIA, PARAS BATUK, MD
6/4/2010
12/15/2011
J1761
N7743
6/3/2011
9/15/2010
N5350
RAMOS, CARLOS E, MD
RAMOS, DAVID ANTHONY, MD
RAMOS, ENRIQUE CISNEROS JR,
DO
P7839
RAMOS, JESUS MIGUEL, MD
8/30/2013
P6505
RAMOS-DURAN, LUIS RAUL, MD
5/1/2013
N9284
RAMPRASAD, JONATHAN ROBERT,
MD
4/1/2011
N5960
P7338
1/3/2011
7/15/2010
4/9/2010
10/1/2010
6/3/2011
2/5/2010
INFECTIOUS
6/8/2017 DISEASES
PEDIATRIC
Practice City
INTERNAL MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/2/2012 None
N/A
1/3/2011 None
7/21/2010 None
N/A
N/A
6/8/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/21/2013 None
N/A
8/1/2013 None
N/A
4/9/2010 None
N/A
HOUSTON
TX
8/1/2018 NEUROLOGY
ALLERGY AND
4/9/2015 IMMUNOLOGY
OBSTETRICS AND
IRVING
TX
DALLAS
TX
ACTIVE
7/30/2013 None
N/A
PEDIATRIC
HEMATOLOGY/ONCOL
6/3/2016 OGY
PEDIATRICS
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
SURGERY
FAMILY PRACTICE 8/21/2014 FAMILY PRACTICE
EMERGENCY MED
TEMPLE
TX
ACTIVE
10/11/2010 None
N/A
HOUSTON
TX
ACTIVE
6/14/2011 None
N/A
BROWNSVILL
E
TX
ACTIVE
8/31/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
9/10/2009 None
N/A
6/4/2010 None
12/26/2011 None
N/A
N/A
6/13/2011 None
10/5/2010 None
N/A
N/A
2/5/2010 None
N/A
6/4/2015 PEDIATRICS
BRYAN
TX
LUBBOCK
TX
6/3/2016 UROLOGY
UROLOGIC SURGERY PANAMA CITY FL
FAMILY MEDICINE
SAN ANTONIO TX
PHYSICAL MED. &
DIAGNOSTIC
5/1/2018 RADIOLOGY
CARDIOLOGY
4/1/2016 PEDIATRICS
AUSTIN
NEURO-RADIOLOGY EL PASO
PEDIATRIC
GASTROENTEROLOG
Y
Page 224 of 300
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
9/4/2013 None
N/A
TX
ACTIVE
5/8/2013 None
N/A
ACTIVE
4/6/2011 None
N/A
License
Number
N9403
Physician Name
RAMSEY, JOSEPH ALONZO, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
4/8/2011
4/8/2016 MEDICINE
URGENT CARE
10/1/2012
10/1/2017 MEDICINE
OBSTETRICS AND
12/12/2008
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICINE
MATERNAL AND
FETAL MEDICINE
Practice City
P4608
RAMSEY, PAMELA MCVEY, MD
N1846
RAMSEY, PATRICK SHANNON, MD
P1394
RANA, BILAL A, DO
11/4/2011
CRITICAL CARE
ANESTHESIOLOGY
N2750
P1014
RANA, IRFAN RAFIQ, MD
RANA, SHAUNAK, MD
4/3/2009
9/15/2011
INTERNAL MEDICINE
N6598
N4691
RANA, SHITAL MANOHAR, MD
RANDALL, STEVE ERIC, MD
6/4/2010
11/6/2009
N5351
RANDHAWA, SHAHID RASUL, MD
2/5/2010
P3570
P2054
RANDLE, KELLEE LORRAINE, DO
RANE, POONAM N, MD
6/8/2012
2/1/2012
P7549
RANGANATH, RAMAKRISHNAN, MD
8/1/2013
N7576
RANNE, RICHARD DOUGLAS, MD
RANNULU, SUDATH GUNADEERA,
MD
8/27/2010
CARDIOVASCULAR
8/1/2018 DISEASES
PEDIATRIC
CARDIOTHORACIC
8/27/2015 SURGERY
8/1/2013
8/1/2018 PEDIATRICS
RAO, ANURADHA T, MD
RAO, BHASKAR, MD
RAO, KRISHNASREE KASUGANTI,
MD
RAO, KRISHNASWAMY JYOTSNA,
MD
RAO, SILPA, MD
RAO, TARA ANANTHA, MD
RASHEED, NIDA, MD
RASHID, SAMIYA, DO
RASHID, SUMIA , MD
RATLIFF, JEANINE LOUISE DAVIS,
MD
2/5/2010
9/17/2012
2/5/2015 RADIOLOGY
BODY IMAGING
8/15/2013
INTERNAL MEDICINE
8/30/2013
7/15/2011
5/15/2012
5/15/2013
1/15/2013
10/1/2012
PEDIATRIC
1/15/2018 NEUROLOGY
5/15/2013
P7550
N5352
P4501
P7694
P7840
P0474
P3232
P6704
P5302
M8938
P6706
SPORTS MEDICINE
ALLERGY AND
IMMUNOLOGY
INTERVENTIONAL
CARDIOLOGY
SAN ANGELO
TX
ACTIVE
SAN ANTONIO TX
ACTIVE
HOUSTON
GRAND
SALINE
TX
ACTIVE
TX
FT. WORTH
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
EL PASO
RICHMOND
DALLAS
PEDIATRICS
Page 225 of 300
GALVESTON
Disciplinary
Status Date
4/8/2011 None
N/A
10/3/2012 None
N/A
4/21/2009 None
UNDER
BOARD
12/19/2011 ORDER
N/A
11/4/2011
N/A
N/A
6/4/2010 None
11/13/2009 None
N/A
N/A
2/5/2010 None
N/A
6/8/2012 None
2/6/2012 None
N/A
N/A
ACTIVE
8/7/2013 None
N/A
TX
ACTIVE
9/3/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/16/2013 None
N/A
2/5/2010 None
10/8/2012 None
N/A
N/A
8/15/2013 None
N/A
TX
MO
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
9/4/2013
7/25/2011
5/22/2012
5/20/2013
1/18/2013
10/8/2012
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
TX
ACTIVE
5/31/2013 None
N/A
TX
TX
TX
TX
FAMILY PRACTICE
AUSTIN
INTERNAL MEDICINE ST LOUIS
Registration
Status Date
Disciplinary
Status of
Texas
License
4/15/2009 None
11/4/2011 None
SPRINGFIELD MA
PEDIATRIC SURGERY LUBBOCK
ADOLESCENT
MEDICINE - PD
CEDAR HILL
PEDIATRICS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
License
Number
P2766
Physician Name
RATNAYAKE, MAHESHIKA
KALPANA, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/2/2012
P7551
RATSIU, JOANA MARIA, MD
8/1/2013
P4502
N6603
RAU, RACHEL ELIZABETH, MD
RAVAL, BRIJESH ARVINDKUMAR,
MD
J7150
RAVIPATI, MAHIPAL, MD
6/4/2010
N6604
RAVURI, SUMAN CHANDRA, MD
6/4/2010
P6066
P6896
P7022
RAWAT, ANISH , MD
RAY, JOHN KINDLEY, MD
RAY, KATIE LAEL KUCERA, MD
4/1/2013
6/3/2013
6/14/2013
N1850
P2511
RAY, THADDEUS ALEXAS, DO
RAZA, ALI, MD
12/12/2008
3/15/2012
N8565
RAZA, HYDER , MD
P2767
RAZA, SHAKEEL, MD
4/2/2012
P6508
RAZA, SYED ARMAN, MD
5/1/2013
N8449
RAZA, ZAMAR FATIMA, MD
1/3/2011
9/17/2012
6/4/2010
1/18/2011
P7695
RAZVI, SHEHLA SYED, MD
8/15/2013
P6707
READER, SARA DWYER, MD
5/15/2013
N5965
READES, ROSALYN NICOLE, MD
4/9/2010
Secondary Specialty
(Self-Designated)
Practice City
GARLAND
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
GRAPEVINE
PEDIATRIC
HEMATOLOGY/ONCOL
9/17/2017 OGY
HOUSTON
INFECTIOUS
6/4/2015 DISEASES
INTERNAL MEDICINE
ALLERGY AND
6/4/2015 IMMUNOLOGY
EVANSVILLE
INTERNAL MEDICINE
EMERGENCY
4/1/2018 MEDICINE
PAIN
MANAGEMENT/REHAB PHYSICAL MED. &
12/12/2013 MED
REHABILITATION
THORACIC
CARDIOVASCULAR
CHILD AND
ADOLESCENT
4/2/2017 PSYCHIATRY
PSYCHIATRY
CARDIOVASCULAR
INTERVENTIONAL
5/1/2018 DISEASES
CARDIOLOGY
Registration
Status of
Practice
Texas
State
License
ACTIVE
4/16/2012 None
N/A
TX
ACTIVE
9/9/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
9/24/2012 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
4/3/2013 None
6/7/2013 None
6/20/2013 None
N/A
N/A
N/A
ACTIVE
ACTIVE
2/23/2009 None
4/26/2012 None
N/A
N/A
LICENSE
ISSUED
1/18/2011 None
N/A
4/6/2012 None
N/A
5/29/2013 None
N/A
1/3/2011 None
N/A
ACTIVE
9/9/2013 None
N/A
ACTIVE
5/27/2013 None
N/A
ACTIVE
4/16/2010 None
N/A
IN
ALPINE
MARFA
TX
TX
DES MOINES
IA
MOBILE
AL
ACTIVE
KINGWOOD
TX
ACTIVE
LICENSE
ISSUED
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
TX
JACKSONVILL
E
FL
DALLAS
Page 226 of 300
Disciplinary
Status Date
TX
EMERGENCY
5/15/2018 MEDICINE
EMERGENCY
4/9/2015 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
N6607
Physician Name
N2752
REARDON, RYAN SCOTT, MD
RECAVARREN ASENCIOS,
ROSEMARY ABIGAIL, MD
P0280
RECIO-RESTREPO, MARIA
VICTORIA, MD
N4692
RECKSON, MARK, MD
P4699
REDCROSS, JOSEPH II, DO
N4693
REDDY, ARVIND CHERKU, MD
N7654
REDDY, ASHWINI PASUNOORI, MD
N8450
P2160
REDDY, JAGADESHWAR GUMMI,
MD
REDDY, MADHUSUDHAN
POTHIREDDY, MD
REDDY, MEDAPALLY PRADEEP,
MD
REDDY, PRASHANT , DO
P1810
REDDY, SIREESHA YERRADHODDI,
MD
N4694
REDDY, SOWMYA, MD
N1852
REDMOND, ANDY JUNEY, MD
P4503
P1133
N8711
REED, JANELLE LOUISE, MD
REEDER, KRISTEN NICOLE, MD
REESE, ERIN ADAIRE, MD
N5356
REESE, JEFFREY C, MD
REESE-HOLLEY, MELODI NICHOLE,
MD
P3233
N2753
P6897
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
6/4/2010
6/4/2015 SURGERY
SURGERY
4/3/2009
4/3/2014 PATHOLOGY
7/1/2011
7/1/2016 NEUROLOGY
11/6/2009
11/6/2014 BODY IMAGING
11/6/2009
5/15/2012
4/3/2009
1/3/2011
2/10/2012
9/1/2015 PEDIATRICS
PULMONARY
CRITICAL CARE
5/15/2017 MEDICINE
DIAGNOSTIC
4/3/2014 RADIOLOGY
1/2/2012
1/2/2017
11/6/2009
11/6/2014
12/12/2008
12/12/2013
9/17/2012
10/3/2011
2/4/2011
9/17/2017
10/3/2016
2/4/2016
N/A
TX
ACTIVE
4/8/2009 None
N/A
TX
ACTIVE
7/12/2011 None
N/A
ST
PETERSBURG FL
ACTIVE
11/30/2009 None
N/A
ORANGEBURG SC
ACTIVE
10/18/2012 None
N/A
ACTIVE
2/1/2010 None
N/A
ACTIVE
9/6/2010 None
N/A
ACTIVE
5/17/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/29/2009 None
N/A
1/3/2011 None
2/15/2012 None
N/A
N/A
ACTIVE
1/12/2012 None
N/A
ACTIVE
2/1/2010 None
N/A
ACTIVE
1/2/2009 None
N/A
11/22/2012 None
12/5/2011 None
2/9/2011 None
N/A
N/A
N/A
2/5/2010 None
N/A
6/3/2013 None
N/A
GASTROENTEROLOG
Y
TOMBALL
TX
FORT WORTH TX
NUCLEAR MEDICINE KIRKLAND
OBSTETRICS AND
GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
NEUROLOGICAL
SURGERY
EMERGENCY
MEDICINE
PEDIATRICS
INTERNAL MEDICINE
WA
INTERNAL MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
GYNECOLOGY
OTHER SPECIALTY
2/5/2010
TRAUMATIC
2/5/2015 ABDOMINAL SURGERY SURGERY
6/3/2013
6/3/2018 OBSTETRICS
Page 227 of 300
Disciplinary
Status Date
6/4/2010 None
NEURO-PHYSIOLOGY
(NEUROLOGY)
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
EDINBURG
10/15/2012
9/1/2010
Practice City
Registration
Status of
Practice
Texas
State
License
EL PASO
ATHENS
DALLAS
DALLAS
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
P1686
REEVES, DONNY LUPRICE, MD
N9769
REGNER, JUSTIN LEE, MD
N6609
dicaid
dicaid
Agreement
End Date
Designated)
12/15/2011
5/16/2011
REHMAN, ATTA UR, MD
6/4/2010
N6610
P6510
P7553
REICHEL, LEE M, MD
REICHERT, SARAH IRENE, DO
REID, NICOLE L, MD
6/4/2010
5/1/2013
8/1/2013
N4031
REID, RICHARD ROBERT , MD
8/21/2009
N9770
REILAND, ALISON MARIE, MD
5/16/2011
P7841
REINHART, LARS , MD
8/30/2013
6/4/2015 NEUROLOGY
6/4/2015 SURGERY
EMERGENCY
8/21/2014 MEDICINE
EMERGENCY
5/16/2016 MEDICINE
EMERGENCY
8/30/2018 MEDICINE
DIAGNOSTIC
3/1/2016 RADIOLOGY
INTERVENTIONAL
5/29/2014 RADIOLOGY
OBSTETRICS AND
7/1/2018 GYNECOLOGY
6/3/2018 PEDIATRICS
PEDIATRIC CRITICAL
N8975
P4999
N3269
REINSMITH, LANCE EDWARD, MD
REINSVOLD, THOMAS MICHAEL,
MD
REISINGER, WILLIAM E, MD
P7192
P6898
REKHI, JASWINDER, DO
RELPH, ANDREW JAMES, DO
N4032
RELVAS, MONICA DE STEFANI, MD
P6511
P7554
N9288
P6899
REMICK, KATHERINE ELIZABETH,
MD
REMSTER, ERIC MICHAEL, MD
REN, JIE, MD
3/1/2011
11/30/2012
5/29/2009
7/1/2013
6/3/2013
8/21/2009
5/1/2013
8/1/2013
4/1/2011
6/3/2013
P3423
RENCHER, LOGAN , DO
RENDON GARCIA, JUAN JESUS,
MD
P3065
RENGO, RENA BURLINGAME, MD
5/1/2012
6/1/2012
5/1/2018 PEDIATRICS
8/1/2018 PEDIATRICS
PEDIATRIC
EMERGENCY
ANATOMIC/CLINICAL
5/1/2017 PATHOLOGY
Secondary Specialty
(Self-Designated)
Practice City
OPHTHALMOLOGY - CORPUS
RECONST SURGERY CHRISTI
CRITICAL CARE
(SURGERY)
TEMPLE
VASCULAR
NEUROLOGY
ORTHOPEDICS
HOSPITALIST
HOUSTON
HILLSBORO
DALLAS
MUSCULOSKELETAL
RADIOLOGY
SAINT LOUIS
CARDIOVASCULAR
DISEASES
NUCLEAR MEDICINE
LAKE
JACKSON
AMARILLO
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
NEUROLOGY
CRITICAL CARE
(SURGERY)
DERMATOPATHOLO
GY
Page 228 of 300
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
TX
TX
TX
MO
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/26/2011 None
N/A
5/27/2011 None
N/A
6/4/2010 None
N/A
6/4/2010 None
5/20/2013 None
8/19/2013 None
N/A
N/A
N/A
ACTIVE
11/13/2009 None
N/A
ACTIVE
5/19/2011 None
N/A
ACTIVE
9/9/2013 None
N/A
3/14/2011 None
N/A
11/30/2012 None
8/31/2009 None
N/A
N/A
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
TX
ACTIVE
ACTIVE
8/7/2013 None
6/7/2013 None
N/A
N/A
LUBBOCK
TX
ACTIVE
8/27/2009 None
N/A
AUSTIN
DALLAS
ST. LOUIS
TX
TX
MO
ACTIVE
ACTIVE
ACTIVE
5/17/2013 None
8/20/2013 None
4/11/2011 None
N/A
N/A
N/A
LICENSE
ISSUED
6/3/2013 None
N/A
ACTIVE
6/8/2012 None
N/A
ACTIVE
5/7/2012 None
N/A
MCALLEN
TX
License
Number
P6900
N4696
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N5968
REQUENEZ, EDWARD, MD
RESES, JOSEPH DAVID, MD
RESPICIO, GUADA REMUDARO,
MD
6/3/2013
11/6/2009
4/9/2010
P5453
REYES, DAVID , MD
2/1/2013
EMERGENCY
11/1/2017 MEDICINE
INTERVENTIONAL
3/1/2017 CARDIOLOGY
4/9/2015 PEDIATRICS
OBSTETRICS AND
3/1/2017 GYNECOLOGY
P4804
REYES, LUIS, MD
P2349
N5969
REYES, MANUEL MUNOZ, MD
REYNA, RICARDO III, MD
3/1/2012
4/9/2010
P2351
REYNOLDS, MARION ARLEEN, MD
3/1/2012
11/1/2012
Secondary Specialty
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Practice City
MCALLEN
TX
SAN ANTONIO TX
INTERNAL MEDICINE
AEROSPACE
MEDICINE
GALVESTON
CARDIOLOGY
HOUSTON
EL PASO
COLORADO
CITY
N8977
REYNOLDS, MICHAEL BRYAN, DO
3/1/2011
N6612
REZAIE, SALIM R, MD
6/4/2010
N8713
RHEE, RICHARD JINHO, MD
2/4/2011
DIAGNOSTIC
2/4/2016 RADIOLOGY
N8566
RHETT, ESI MOROWA, MD
1/18/2011
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
TX
ORTHOPEDIC
SURGERY OF THE
SPINE
N2754
RHIM, RICHARD DONGIL , MD
P6709
N7166
RHOADES, COURTNEY PAIGE, DO
RHODES, RAMONA , MD
N5970
RHODES, RICHARD D, MD
N3270
RHOTON, WILLIAM ALAN , MD
5/29/2009
ORTHOPEDIC
4/3/2014 SURGERY
OBSTETRICS AND
ORTHOPEDIC
4/9/2015 SURGERY
PULMONARY
CRITICAL CARE
5/29/2014 MEDICINE
N7745
RIAD, MAGGY G., MD
9/15/2010
THE
INTERNAL MEDICINE WOODLANDS TX
CRITICAL CARE
MEDICINE
LOS ANGELES CA
P6710
N7167
RIAZ, JAWAD, MD
RIAZ, SOHAIL, MD
RIBARNE PASZTOR, GABRIELLA ,
MD
5/15/2013
7/15/2010
SLEEP MEDICINE
5/29/2009
N3271
4/3/2009
5/15/2013
7/15/2010
4/9/2010
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/10/2013 None
11/24/2009 None
N/A
N/A
4/9/2010 None
N/A
ACTIVE
2/6/2013 None
N/A
ACTIVE
11/5/2012 None
N/A
ACTIVE
ACTIVE
3/5/2012 None
4/15/2010 None
N/A
N/A
ACTIVE
3/5/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
3/15/2011 None
N/A
6/4/2010 None
N/A
2/4/2011 None
N/A
1/18/2011 None
N/A
ACTIVE
4/15/2009 None
N/A
TX
ACTIVE
ACTIVE
6/4/2013 None
7/27/2010 None
N/A
N/A
EULESS
TX
ACTIVE
4/27/2010 None
N/A
ACTIVE
6/12/2009 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
9/23/2010 None
N/A
5/15/2013 None
7/20/2010 None
N/A
N/A
ACTIVE
7/27/2009 None
N/A
Page 229 of 300
License
Number
Physician Name
P6255
RIBEIRO, ANNELISE NATASHA, MD
P1811
RICARD, BRANDY C, MD
P0784
RICE, CHRISTION GREGORY, MD
N5359
P7696
P7023
P2056
dicaid
dicaid
Agreement
End Date
Designated)
Registration
Status Date
Disciplinary
Status Date
TX
ACTIVE
4/16/2013 None
N/A
PALESTINE
CORPUS
CHRISTI
TX
ACTIVE
1/4/2012 None
N/A
8/15/2011
EMERGENCY
URGENT CARE
8/15/2016 MEDICINE
MEDICINE
TX
8/26/2011 None
N/A
RICE, LEVI ANDREW JR, DO
RICE, LYNN ANN, DO
2/5/2010
8/15/2013
MESA
AZ
ACTIVE
LICENSE
ISSUED
ACTIVE
2/5/2010 None
8/20/2013 None
N/A
N/A
6/14/2013
2/1/2012
TX
TX
ACTIVE
ACTIVE
7/10/2013 None
2/9/2012 None
N/A
N/A
TX
ACTIVE
12/26/2012 None
N/A
TX
ACTIVE
12/26/2012 None
N/A
L6157
RICHANI, KARINA, MD
RICHARDS, JOHN CALEB, MD
RICHARDSON, ALVIE CLIFFORD,
MD
MD
MD
TX
ACTIVE
12/26/2012 None
N/A
P0785
RICHARDSON, KEVIN DEWAYNE,
DO
8/15/2011
ORTHOPEDIC
8/15/2016 SURGERY
LICENSE
ISSUED
8/15/2011 None
N/A
P0121
RICHARDSON, MICHAEL L JR, MD
6/15/2011
ACTIVE
6/20/2011 None
N/A
P2352
N7335
RICHEY, JONATHAN D, DO
RICHMOND, TERIYA MONICK, MD
3/1/2012
8/2/2010
ACTIVE
ACTIVE
3/5/2012 None
9/20/2010 None
N/A
N/A
N4039
RICO, FERDINAND REYES, MD
9/8/2009 None
N/A
N5361
RIDDLE, CHRISTY CATHLEEN, MD
2/5/2010 None
N/A
P3424
P4903
P7341
6/1/2012 None
11/26/2012 None
7/18/2013 None
N/A
N/A
N/A
H1526
P3234
RIDLEY, RYAN WINTRELL, MD
RIEBEL, HEATHER ROSE, MD
RIGGS, JENNIFER LYNN, MD
RIGNEY, CHARLES EDWARD III,
MD
RIHANI, JORDAN JOSEPH, MD
11/9/2012 None
5/22/2012 None
N/A
N/A
P7842
RILEY, CYNTHIA R, MD
8/30/2013 None
N/A
L6157
1/2/2012
12/17/2012
12/17/2012
12/17/2012
8/21/2009
2/5/2010
6/1/2012
11/15/2012
7/15/2013
11/1/2012
5/15/2012
8/30/2013
Practice City
Disciplinary
Status of
Texas
License
QUITMAN
L6157
4/12/2013
Secondary Specialty
(Self-Designated)
PEDIATRIC
NEPHROLOGY
Registration
Status of
Practice
Texas
State
License
2/1/2017 RADIOLOGY
MATERNAL AND
MATERNAL AND
MATERNAL AND
HOSPITALIST
HOUSTON
OBSTETRICS AND
GYNECOLOGY
AUSTIN
OBSTETRICS AND
GYNECOLOGY
AUSTIN
OBSTETRICS AND
GYNECOLOGY
AUSTIN
ORTHOPEDIC
SURGERY OF THE
SPINE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
FORT WORTH
DERMATOLOGIC
SURGERY
SURGICAL CRITICAL CORPUS
CHRISTI
TX
TX
SAN ANTONIO TX
ODESSA
TX
GENERAL PRACTICE DEL RIO
PHYSICAL MED. &
Page 230 of 300
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P7697
RILEY, MARISTELLA, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/15/2013
PLASTIC &
RECONSTRUCTIVE
4/9/2010
4/9/2015 SURGERY
LICENSE
ISSUED
UROLOGIC SURGERY LUBBOCK
TX
12/17/2017 UROLOGY
12/17/2017 UROLOGY
FORT SAM
HOUSTON
RINARD, JEREMY RONALD, MD
P5123
RINARD, KATHERINE LEIGH, MD
12/17/2012
12/17/2017 UROLOGY
P5123
12/17/2012
P5123
12/17/2012
P1397
RINCON, ENRIQUE JOSE
ANTONIO, MD
P6256
N8238
RINGLER, ROBERT LLOYD JR, MD
RIOJAS, MARCELA , MD
P1812
RIOS PEREZ, JIMMI, MD
P1216
RISCH, ROBERT MARTIN, MD
P6257
RISNER, DAVID SCHULLER JR, MD
K2270
RITTER, STEVEN EKBERG, MD
P3426
6/1/2012
P6902
RIVERA JIMENEZ, JOEL R, MD
RIVERA PABON, FRANCISCO
RAFAEL, MD
P6903
RIVERA VAZQUEZ, MARIMER , MD
6/3/2013
N9483
RIVERA, DINA CELINE, MD
4/15/2011
N8840
RIVERA, NICOLAS BRAVO JR, MD
2/15/2011
N6616
6/4/2010
P7698
RIVERA, RACHEL , MD
RIVERA-SOTO, ANGEL MANUEL,
MD
P3066
RIVERO, GUSTAVO , MD
4/12/2013
12/1/2010
1/2/2012
10/17/2011
4/12/2013
12/15/2011
6/3/2013
8/15/2013
5/1/2012
Practice City
TX
N5973
11/4/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
ACTIVE
4/9/2010 None
N/A
ACTIVE
12/20/2012 None
N/A
TX
ACTIVE
12/20/2012 None
N/A
TX
ACTIVE
12/20/2012 None
N/A
TX
ACTIVE
11/14/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/17/2013 None
1/10/2011 None
N/A
N/A
1/2/2012 None
N/A
TX
ACTIVE
11/8/2011 None
N/A
TX
ACTIVE
4/22/2013 None
N/A
SAN ANTONIO TX
ACTIVE
12/22/2011 None
N/A
MCALLEN
ACTIVE
LICENSE
ISSUED
6/8/2012 None
N/A
6/3/2013 None
N/A
FAMILY MEDICINE
ENDOCRINOLOGY,
DIABETES AND
INTERNAL MEDICINE
PEDIATRIC INTENSIVE
2/15/2016 CARE
PEDIATRICS
INFECTIOUS
6/4/2015 INTERNAL MEDICINE DISEASES
ACTIVE
7/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/27/2011 None
N/A
2/15/2011 None
N/A
6/4/2010 None
N/A
8/15/2018 GENERAL PRACTICE INTERNAL MEDICINE
HEMATOLOGY/ONCOL
5/1/2017 OGY
HOUSTON
Page 231 of 300
ACTIVE
8/26/2013 None
N/A
ACTIVE
6/28/2012 None
N/A
OBSTETRICS AND
1/2/2017 GYNECOLOGY
EMERGENCY
10/17/2016 MEDICINE
DERMATOLOGIC
12/15/2016 SURGERY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
TEMPLE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/19/2013 None
N/A
FAMILY MEDICINE
CEDAR PARK TX
SAN ANTONIO TX
GRAPEVINE
OPHTHALMOLOGY ANTERIOR SURGERY TYLER
DERMATOLOGY
TX
TX
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
Practice City
RIVERS, AEISHA KEKHIA STIMAGE,
SURGICAL BREAST
P7193
MD
7/1/2013
7/1/2018 ONCOLOGY
ANESTHESIOLOGY P7843
RIXTER, DAVIDA DENISE, MD
8/30/2013
PAIN MANAGEMENT
RIZVI, SHAFQAT NA, MD
P0667
RIZVI, SYED ZULFIQAR HYDER, MD
8/1/2011
P5563
2/8/2013
P5564
RIZZO, ANNE GRACE, MD
ROA, MARIO RIZALINO BASCON
JR, MD
ROBERSON, RUSSELL STUART,
MD
N5364
ROBERT, MARSHALL BROOKS, MD
N8567
ROBERTS, JOHN R, MD
N5975
P0480
ROBERTS, STEPHEN JAN, MD
ROBINSON, CHRISTINA, MD
N1861
ROBINSON, DEREK JERMAINE, MD
10/1/2010
2/5/2010
4/9/2010
7/15/2011
12/12/2008
ORTHOPEDIC
SURGERY
4/9/2015
EMERGENCY
12/12/2013 MEDICINE
6/14/2013
N6973
P0481
RODE, ANURADHA SANJAY, MD
RODE, RASHMI, MD
7/1/2010
7/15/2011
OBSTETRICS AND
7/1/2015 GYNECOLOGY
P6258
RODGERS, KATHERINE ANNA, MD
RODNEY, JOHN ROCCO
MACMILLAN, MD
4/12/2013
11/6/2009
9/15/2011
ORTHOPEDIC
2/1/2017 SURGERY
EMERGENCY
9/15/2016 MEDICINE
4/12/2013
P1017
P6259
P5231
RODRIGO, JUAN JOSE, MD
RODRIGUEZ ACOSTA, MANUEL
EDUARDO, MD
RODRIGUEZ CASTRO, CARLOS E,
MD
RODRIGUEZ MUNOZ, MARIA
VICTORIA, MD
2/1/2012
1/4/2013
1/4/2018 PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
7/15/2013 None
Disciplinary
Status Date
N/A
8/30/2013 None
UNDER
BOARD
11/30/2012 ORDER
N/A
8/1/2011 None
N/A
11/30/2012
WICHITA
FALLS
TX
ACTIVE
2/18/2013 None
N/A
MUENSTER
TX
ACTIVE
10/12/2010 None
N/A
CHAPEL HILL
NC
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/12/2013 None
N/A
2/5/2010 None
N/A
1/18/2011 None
N/A
LUBBOCK
SAN ANGELO
TX
TX
ACTIVE
ACTIVE
4/19/2010 None
7/21/2011 None
N/A
N/A
AUGUSTA
GA
ACTIVE
2/16/2009 None
N/A
TX
ACTIVE
6/24/2013 None
N/A
FAMILY PRACTICE
HOUSTON
ELK GROVE
VILLAGE
HOUSTON
IL
TX
ACTIVE
ACTIVE
7/15/2010 None
7/21/2011 None
N/A
N/A
HOSPITALIST
DALLAS
TX
ACTIVE
4/24/2013 None
N/A
FORT WORTH TX
ACTIVE
11/16/2009 None
N/A
WACO
TX
ACTIVE
2/29/2012 None
N/A
AMARILLO
TX
ACTIVE
9/19/2011 None
N/A
TX
ACTIVE
4/24/2013 None
N/A
TX
ACTIVE
2/28/2013 None
N/A
ROBINSON, SHAUN B, MD
P2059
CRITICAL CARE
ANESTHESIOLOGY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
P7027
N4707
TRAUMATIC
SURGERY
2/8/2013
1/18/2011
TX
ADDICTION
PSYCHIATRY
P5000
N7865
11/30/2012
Registration
Status of
Practice
Texas
State
License
ARTHRITIS & JOINT
IMPLANT SURGERY
CORPUS
CHRISTI
Page 232 of 300
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1134
RODRIGUEZ, ANA VERONICA, MD
P1219
N2761
RODRIGUEZ, AXEL , MD
RODRIGUEZ, CARLOS LUIS, MD
P3429
RODRIGUEZ, CARMEN , MD
N3276
RODRIGUEZ, CELSO ANTONIO, MD
5/29/2009
N6975
RODRIGUEZ, DAVID MICHAEL, MD
7/1/2010
N6976
RODRIGUEZ, GABRIEL ANGEL, MD
7/1/2010
P5565
RODRIGUEZ, GUSTAVO JOSE, MD
2/8/2013
N5977
RODRIGUEZ, JORGE IVAN, MD
4/9/2010
P0870
P1016
RODRIGUEZ, JOSE ANTONIO, MD
RODRIGUEZ, JOSE RUBEN, MD
N6623
P6512
P0284
P0871
RODRIGUEZ, JOSEPH ANTHONY,
MD
RODRIGUEZ, LIMAEL ESTEBAN,
MD
RODRIGUEZ, LORNA, MD
RODRIGUEZ, MARISOL LOREDO,
MD
Practice City
10/3/2011
HOUSTON
TX
10/17/2011
4/3/2009
HOUSTON
TX
6/1/2012
8/26/2011
9/15/2011
6/4/2010
5/1/2013
7/1/2011
OBSTETRICS AND
PEDIATRIC EMER MED
7/1/2015 (PEDS)
PEDIATRICS
ANESTHESIOLOGY
ENDOVASCULAR
VASCULAR
SURGICAL
2/8/2018 NEUROLOGY
NEURORADIOLOGY
HEMATOLOGY/ONCOL
4/9/2015 OGY
INTERNAL MEDICINE
SPORTS MEDICINE
(FAMILY PRACTICE)
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
6/4/2015 GYNECOLOGY
SURGERY
OBSTETRICS AND
7/1/2016 GYNECOLOGY
MATERNAL AND
FETAL MEDICINE
8/26/2011
7/15/2013
UROLOGIC
7/15/2018 UROLOGIC SURGERY ONCOLOGY
P7343
RODRIGUEZ, RONALD , MD
N5366
RODRIGUEZ, SIMON SERGIO, MD
2/5/2010
2/5/2015 NEPHROLOGY
N9632
RODRIGUEZ, VICTOR M, MD
5/2/2011
P0123
RODRIGUEZ, VICTOR RAMON, MD
RODRIGUEZ-QUINONES, JULIO
JOSE, MD
P0786
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
6/15/2011
8/15/2011
10/6/2011 None
N/A
10/17/2011 None
4/15/2009 None
N/A
N/A
6/1/2012 None
N/A
TX
ACTIVE
6/3/2009 None
N/A
DALLAS
TX
ACTIVE
7/22/2010 None
N/A
IRVING
TX
ACTIVE
7/12/2010 None
N/A
EL PASO
TX
ACTIVE
2/12/2013 None
N/A
4/21/2010 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/26/2011 None
9/19/2011 None
N/A
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
ACTIVE
5/7/2013 None
N/A
ACTIVE
LICENSE
ISSUED
7/29/2011 None
N/A
8/26/2011 None
N/A
ACTIVE
LICENSE
ISSUED
7/22/2013 None
N/A
2/5/2010 None
N/A
5/9/2011 None
N/A
6/21/2011 None
N/A
8/15/2011 None
N/A
HOUSTON
ARLINGTON
TX
SAN ANTONIO TX
ACTIVE
OLEAN
Page 233 of 300
Disciplinary
Status Date
HOUSTON
INTERNAL MEDICINE
VASCULAR
SURGERY
6/15/2016 RADIOLOGY
EMERGENCY
8/15/2016 MEDICINE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
NY
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N4708
RODRIGUEZ-RICO, DANIELLA , MD
11/6/2009
P5458
N9771
ROEHM, CORRIE ELIZABETH, MD
ROESER, MARK ELLIOT, MD
2/1/2013
5/16/2011
N6624
ROETH, NATHAN ADAM, MD
P1688
ROFAIEL, GEORGE, MD
P1952
ROFSKY, NEIL M, MD
1/17/2012
N9772
ROGERS, GREGORY B, MD
5/16/2011
G0023
ROGERS, WILLIAM BRETT, MD
H3514
ROH, MARK STEPHEN, MD
6/4/2010
12/15/2011
7/1/2013
12/12/2008
P4505
ROHM, TREVOR , MD
9/17/2012
P6260
ROHRA, ANITA, MD
4/12/2013
P3574
ROIG ROJAS, INGRID LIDIA, MD
6/8/2012
N9945
ROJAS SANTAMARIA, ISABEL
CRISTINA, MD
6/3/2011
P1689
P6069
ROLAND, CYNTHIA RENEE, MD
ROLDAN, GUADALUPE , MD
P3430
ROMAN, NICHOLAS ORDUNO, MD
P1399
N9946
ROMEO, BRUNO A, MD
ROMERO, ALICIA BEATRIZ, MD
11/4/2011
6/3/2011
N1111
ROMERO, REBECCA SUZANNE, MD
8/29/2008
N2762
ROOPANI, GHAZALA QUDDUS, MD
4/3/2009
12/15/2011
4/1/2013
6/1/2012
PEDIATRIC
TRANSPLANT
12/15/2016 SURGERY
DIAGNOSTIC
1/17/2017 RADIOLOGY
Secondary Specialty
(Self-Designated)
PHARR
OTORHINOLARYNGO
LOGY
HOUSTON
TX
ACTIVE
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/30/2009 None
N/A
2/11/2013 None
5/24/2011 None
N/A
N/A
6/4/2010 None
N/A
3/2/2012 None
N/A
GENERAL SURGERY SEATTLE
WA
ACTIVE
NUCLEAR MEDICINE DALLAS
TX
ACTIVE
LICENSE
ISSUED
2/16/2012 None
N/A
5/16/2011 None
N/A
7/12/2013 None
N/A
3/12/2009 None
N/A
FAMILY MEDICINE
SURGICAL
12/12/2013 ONCOLOGY
EMERGENCY
4/12/2018 MEDICINE
INFECTIOUS
6/8/2017 DISEASES
INTERNAL MEDICINE
PEDIATRIC
GASTROENTEROLOG
6/3/2016 Y
PEDIATRICS
OBSTETRICS AND
RADIATION
6/1/2017 ONCOLOGY
OBSTETRICS &
GYNECOLOGICAL
11/4/2016 SURGERY
8/29/2013 NEUROLOGY
4/3/2014 NEPHROLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
DOWAGIAC
MI
HOUSTON
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
QUANAH
TX
ACTIVE
9/24/2012 None
N/A
FLUSHING
NY
4/30/2013 None
N/A
HUNTSVILLE
AL
ACTIVE
LICENSE
ISSUED
6/8/2012 None
N/A
6/3/2011 None
N/A
12/19/2011 None
4/15/2013 None
N/A
N/A
LICENSE
ISSUED
ACTIVE
ACTIVE
SAN ANTONIO TX
CHICAGO
INTERNAL MEDICINE BAY PINES
Page 234 of 300
ACTIVE
N/A
LICENSE
ISSUED
ACTIVE
6/11/2012 None
SEE
PREVIOUS
11/4/2011 ORDER
6/10/2011 None
IL
ACTIVE
9/26/2008 None
N/A
FL
ACTIVE
6/19/2009 None
N/A
12/13/2011
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
N1433
Physician Name
ROOPIREDDY, SREEKANTH
REDDY, MD
P1922
ROOSTAEIAN, JASON, MD
1/17/2012
P0124
P1136
ROOT, JEFFREY ROBERT, MD
ROOT, JOHN CHINNICK, MD
6/15/2011
10/3/2011
P0668
ROOT, TIMOTHY DANFORTH, MD
8/1/2011
P6905
ROSALEZ, MISSY NEDA, MD
6/3/2013
H5202
P5460
ROSANE, BRET, MD
ROSARIO FELICIANO, RALPHIE
ALBERTO, MD
N4046
ROSAS BLUM, EDUARDO DANIEL,
MD
P3067
ROSAS, LUIS ALBERTO, MD
5/1/2012
P7558
ROSE, CARY, MD
8/1/2013
N6125
ROSE, JERI KING, DO
6/4/2010
P2773
P7344
N9635
ROSEBROCK, RICHARD ERIC, MD
ROSEMAN, JOHN TYLER II, MD
ROSENBERRY, CLARK MICHAEL,
MD
P5461
ROSENGART, TODD KENNETH, MD
N9773
N1868
N5980
ROSENTHAL, DAVID SCOTT, MD
ROSERO, RAMIRO RENE, MD
ROSHEK, THOMAS BANCROFT III,
MD
N9404
ROSILLO, PATRICIA LIZETTE, MD
10/10/2008
PLASTIC &
RECONSTRUCTIVE
1/17/2017 SURGERY
4/12/2013
EMERGENCY
8/1/2016 MEDICINE
GERIATRIC MEDICINE
OTORHINOLARYNGOL
4/12/2018 OGY
2/1/2013
8/21/2009
4/2/2012
7/15/2013
5/2/2011
2/1/2013
5/16/2011
12/12/2008
Secondary Specialty
(Self-Designated)
CARDIOVASCULAR
8/1/2018 DISEASES
EMERGENCY
6/4/2015 MEDICINE
Practice City
LOCKHART
Registration
Status of
Practice
Texas
State
License
TX
GENERAL VASCULAR
SURGERY
ALTUS
OK
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/16/2008 None
N/A
LICENSE
ISSUED
1/17/2012 None
N/A
LICENSE
ISSUED
ACTIVE
6/15/2011 None
10/25/2011 None
N/A
N/A
EMERGENCY
MEDICAL SERVICES
NOBLESVILLE IN
ACTIVE
8/25/2011 None
N/A
FAMILY PRACTICE
LUBBOCK
TX
ACTIVE
6/12/2013 None
N/A
ANCHORAGE
AK
ACTIVE
4/15/2013 None
N/A
TX
ACTIVE
2/7/2013 None
N/A
TX
ACTIVE
9/3/2009 None
N/A
TX
ACTIVE
6/8/2012 None
N/A
TX
8/5/2013 None
N/A
6/4/2010 None
N/A
4/2/2012 None
8/5/2013 None
N/A
N/A
ABILENE
PEDIATRIC
GASTROENTEROLOG
Y
HOUSTON
INFECTIOUS
DISEASES
MCALLEN
CARDIAC
ELECTROPHYSIOLO
GY
LONGVIEW
4/2/2017 RADIOLOGY
NEURO-RADIOLOGY
EMERGENCY
5/2/2016 MEDICINE
CARDIOVASCULAR
2/1/2018 SURGERY
LONGVIEW
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
EL PASO
TX
ACTIVE
5/12/2011 None
N/A
HOUSTON
TX
2/11/2013 None
N/A
LAKEWOOD
CA
ACTIVE
LICENSE
ISSUED
ACTIVE
5/16/2011 None
2/2/2009 None
N/A
N/A
4/9/2010
DALLAS
TX
ACTIVE
4/16/2010 None
N/A
4/8/2011
4/8/2016 INTERNAL MED - PEDS RHEUMATOLOGY
Page 235 of 300
HOUSTON
TX
ACTIVE
4/14/2011 None
N/A
License
Number
Physician Name
P1487
ROSLUND, GREGORY LANE, MD
P4703
ROSS, DAVID JAMES, DO
N8058
P2161
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
11/15/2011
11/15/2016 MEDICINE
EMERGENCY
10/15/2012
10/15/2017 MEDICINE
P6714
N2268
ROSS, JULIE DANIELLE, MD
ROSS, THEODORA S, MD
ROSSMANN, MICHELLE DEBRA,
MD
ROTAN, EDWARD EARL JR, MD
10/29/2010
2/10/2012
P5232
N9636
ROTHSTEIN, ROBERT JOSEPH, MD
ROUF, EMRAN, MD
P5304
ROUNTREE, ANGELA RUTH, MD
1/15/2013
N4049
ROURKE, LOREN LYNN, MD
8/21/2009
P6513
ROWE, ADAM EDWARD, MD
5/1/2013
P5233
L9462
ROY, ANUKUL RANJAN, MD
ROY, JAMES WILLIAM, MD
1/4/2013
7/1/2013
N4051
ROYAL, KRISTIN JOYCE , MD
8/21/2009
P7198
P5884
P2919
RUALES, STEPHANIE RODIS, MD
RUAN, CHENG-HUAI, MD
RUAS, VIRGINIA LAURA, MD
7/1/2013
3/15/2013
4/13/2012
5/15/2013
2/6/2009
1/4/2013
5/2/2011
2/10/2017 ONCOLOGY
DIAGNOSTIC
5/15/2018 RADIOLOGY
EMERGENCY
1/4/2018 MEDICINE
EMERGENCY
1/15/2018 MEDICINE
SURGICAL BREAST
8/21/2014 ONCOLOGY
EMERGENCY
5/1/2018 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
MISHAWAKA
ADDICTION
PSYCHIATRY
INTERNAL MEDICINE
EMERGENCY/TRAUM
A RADIOLOGY
FAMILY MEDICINE
IN
Disciplinary
Status Date
N/A
10/15/2012 None
N/A
10/29/2010 None
2/17/2012 None
N/A
N/A
ACTIVE
ACTIVE
5/22/2013 None
7/6/2009 None
N/A
N/A
ACTIVE
ACTIVE
1/8/2013 None
5/4/2011 None
N/A
N/A
ACTIVE
1/31/2013 None
N/A
TX
ACTIVE
8/25/2009 None
N/A
5/8/2013 None
N/A
HUNTSVILLE
AL
ACTIVE
LICENSE
ISSUED
ACTIVE
1/4/2013 None
7/3/2013 None
N/A
N/A
DALLAS
TX
8/26/2009 None
N/A
MUNCIE
IN
ARLINGTON
TX
7/1/2013 None
3/22/2013 None
4/20/2012 None
N/A
N/A
N/A
6/4/2010 None
N/A
DALLAS
TX
FARMINGTON
HILLS
MI
ARLINGTON
TX
HOUSTON
MD
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
11/28/2011 None
BETHESDA
TEMPLE
PEDIATRIC ANES
(PEDS)
Registration
Status of
Practice
Texas
State
License
TM00369 RUDENSKY, DANIEL ELIEZER, MD
6/4/2010
6/4/2015 RADIOLOGY
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
N9405
RUEDA, JAIME JAVIER, MD
4/8/2011
N/A
7/1/2010
7/1/2010 None
N/A
N4053
RUGER, ERICA PATRICE, MD
RUIZ GONZALEZ, HELBERT
EDUARDO, MD
ACTIVE
LICENSE
ISSUED
4/14/2011 None
N6980
OBSTETRICS AND
7/1/2015 GYNECOLOGY
11/18/2009 None
N/A
N5375
RUIZ, ALBERTO , MD
ACTIVE
LICENSE
ISSUED
2/5/2010 None
N/A
3/9/2009 None
N/A
N2270
RUIZ, PETER ANTHONY, MD
8/21/2009
2/5/2010
2/6/2009
CONWAY
AR
CORPUS
CHRISTI
Page 236 of 300
TX
ACTIVE
License
Number
N7168
N4711
N5985
P5568
Physician Name
RUIZ-BARON, MAURICIO
ALEXANDER, MD
RUOFF, CHAD MICHAEL, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2010
11/6/2009
P1813
P2355
RUSCHER, ADAM, MD
RUSSELL, MICHAEL ADAM, DO
RUTZ, JOSEPH ALEXANDER JR,
MD
RYALI, NEELIMA DEVI R A, MD
4/9/2010
2/8/2013
P1586
RZEPKA, ROBERT , MD
P6070
SAAD, ANTONIO , MD
4/1/2013
P1400
SAAP, LILIANA J, MD
11/4/2011
P6908
N1871
SABA, SALIM CHARLES, MD
SABIA, MICHAEL, MD
P5463
SABIR, SHARJEEL , MD
N1872
P6071
P1814
SABLAN, MARIO KEKONA, DO
SABRI, NADIA A, MD
SABRI, SAMMY , MD
L3546
SACHDEVA, RAJESH, MD
P2776
P0669
SADEGHI, MOHAMMADREZA, MD
SADIGHI, ZSILA SOUSAN, MD
P2163
SADOUN, ELISE YASMEEN, MD
N7338
SAEED, ALIYA, MD
8/2/2010
L3461
SAEED, IBRAHIM MUHAMMAD, MD
7/1/2010
P4506
SAEED, YAHYA, MD
1/2/2012
3/1/2012
12/1/2011
6/3/2013
12/12/2008
2/1/2013
12/12/2008
4/1/2013
1/2/2012
8/29/2008
4/2/2012
8/1/2011
2/10/2012
9/17/2012
EMERGENCY
4/9/2015 MEDICINE
OBSTETRICS AND
1/2/2017 GYNECOLOGY
OBSTETRICS AND
4/1/2018 GYNECOLOGY
PLASTIC &
RECONSTRUCTIVE
6/3/2018 SURGERY
INTERVENTIONAL
2/1/2018 RADIOLOGY
ORTHOPEDIC
12/12/2013 TRAUMA
4/1/2018 PEDIATRICS
8/29/2013 RADIOLOGY
4/2/2017 NEUROLOGY
8/1/2016 NEURO-ONCOLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
ACTIVE
HOUSTON
AUSTIN
TX
TX
ACTIVE
ACTIVE
4/20/2010 None
2/21/2013 None
N/A
N/A
BASTROP
ABILENE
LA
TX
ACTIVE
ACTIVE
1/12/2012 None
3/9/2012 None
N/A
N/A
CONCORD
NH
ACTIVE
1/30/2012 None
N/A
GALVESTON
TX
ACTIVE
4/12/2013 None
N/A
PROVIDENCE RI
ACTIVE
11/28/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
6/4/2013 None
4/29/2009 None
N/A
N/A
TX
ACTIVE
2/4/2013 None
N/A
DALLAS
TX
BIRMINGHAM
AL
ACTIVE
ACTIVE
ACTIVE
1/1/2009 None
4/10/2013 None
1/9/2012 None
N/A
N/A
N/A
CARDIOLOGY
LITTLE ROCK
AR
9/15/2008 None
N/A
CHILD NEUROLOGY
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/2/2012 None
8/5/2011 None
SEE
PREVIOUS
2/10/2012 ORDER
N/A
N/A
INTERNAL MEDICINE
INFECTIOUS
DISEASES
MATERNAL AND
FETAL MEDICINE
DERMATOLOGIC
SURGERY
PAIN MANAGEMENT AUSTIN
DIAGNOSTIC
RADIOLOGY
HOUSTON
LICENSE
ISSUED
LICENSE
ISSUED
CARDIOVASCULAR
7/1/2015 DISEASES
Registration
Status Date
Disciplinary
Status of
Texas
License
INTERNAL MED PEDS
ADDICTION
PSYCHIATRY
Page 237 of 300
NEW HAVEN
CT
7/27/2010 None
11/12/2009 None
N/A
N/A
2/13/2012
8/2/2010 None
N/A
ACTIVE
7/13/2010 None
N/A
ACTIVE
12/12/2012 None
N/A
License
Number
Physician Name
N3284
SAEMI, AZALEA , MD
N2275
SAENZ, LINDA JO, MD
N9123
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
5/29/2009
5/29/2014 MEDICINE
2/6/2009
SAENZ, PAULINA ALEJANDRA, MD
3/15/2011
N4056
N1436
SAFEEK, YISRAEL MORDECAI, MD
SAFFARI, BEHROOZ , MD
8/21/2009
10/10/2008
ADMINISTRATIVE
8/21/2014 MEDICINE
N8059
SAFVI, AMJAD ALI, MD
10/29/2010
TM00438 SAG, RANDY, MD
P0287
SAGALLA, REX B, DO
4/15/2011
7/1/2011
DIAGNOSTIC
4/15/2016 RADIOLOGY
7/1/2011
6/8/2012
6/8/2017 PEDIATRICS
11/6/2009
6/3/2013
P0288
P3575
SAGER, DERICK ALAN, MD
SAGHIER, SADAF, MD
N4713
P6909
SAHARIA, ASHISH , MD
SAHEBJAM, FARHAD, MD
L7871
SAHETA, SANJAYA NARAYAN, MD
P2514
N8141
SAHLOUL, ELSAYED AHMED, MD
SAID, NUHA R, MD
N5988
SAID, RANA RIYAD, MD
N8343
SAIF, NOMAN , MD
12/15/2010
PEDIATRIC
4/9/2015 NEUROLOGY
ENDOCRINOLOGY,
DIABETES AND
P4705
P6072
P1402
SAIYAD, SALEEM, MD
SAJJA, NAVEEN, MD
SAJJAN, RAJENDRA N, MD
SALAKO, OLUBUNMI NKEM
ADEKUMBI, MD
10/15/2012
4/1/2013
11/4/2011
P5234
P0928
SALAMI, OLUFUNMILAYO I, MD
1/4/2013
3/15/2012
11/15/2010
4/9/2010
1/4/2013
9/1/2011
Secondary Specialty
(Self-Designated)
TRANSPLANT
SURGERY
HEPATOLOGY
9/1/2016 PEDIATRICS
ACTIVE
6/12/2009 None
N/A
TX
ACTIVE
3/9/2009 None
N/A
TEMPLE
TX
ACTIVE
4/4/2011 None
N/A
LUBBOCK
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
9/1/2009 None
11/7/2008 None
N/A
N/A
10/29/2010 None
N/A
4/15/2011 None
7/18/2011 None
N/A
N/A
7/1/2011 None
6/26/2012 None
N/A
N/A
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
12/14/2009 None
6/5/2013 None
N/A
N/A
1/4/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/12/2012 None
12/10/2010 None
N/A
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
1/10/2011 None
N/A
10/15/2012 None
4/8/2013 None
11/18/2011 None
N/A
N/A
N/A
1/4/2013 None
N/A
9/28/2011 None
N/A
SUGARLAND
HOUSTON
AL
TX
TX
WASHINGTON PA
DALLAS
TX
PROVIDENCE RI
INTERNAL MEDICINE SALEM
INTERNAL MEDICINE SAN ANGELO
DALLAS
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Page 238 of 300
Disciplinary
Status Date
TX
1/4/2018 PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
TEMPLE
CORPUS
CHRISTI
BIRMINGHAM
INTERVENTIONAL
CARDIOLOGY
1/4/2018 CARDIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
NJ
TX
TX
MINNEAPOLIS MN
ACTIVE
License
Number
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
EMERGENCY
12/12/2008
12/12/2013 MEDICINE
MEDICAL SERVICES
N4057
P3666
P1924
Physician Name
SALAZAR, GILBERTO ANTONIO,
MD
SALAZAR-ALAMILLO, UBALDO
JULIAN , MD
SALCEDO, EVA SAMELLA
SALVACION, MD
SALCIDO, ARMANDO JR, MD
SALDANA, DAVID ABRAM, MD
N8344
K0183
P4808
SALDARRIAGA, ALINA , MD
SALEEM, ASMA, MD
SALEEM, KASHIF , MD
N3409
P2515
SALEEM, MARIAM , MD
SALEEM, SADAF, MD
8/21/2009
3/15/2012
P2516
P1589
SALEEM, SADIA , MD
SALEEM, USMAN, MD
3/15/2012
12/1/2011
P3069
SALGADO GONZALEZ, GONZALO
ALEJANDRO, MD
P4507
N4059
SALHAB, SAMER, MD
SALIB, MICHAEL FAWZY, MD
9/17/2012
8/21/2009
N1121
P4809
8/29/2008
11/1/2012
N5990
SALIB, TAMER , DO
SALIFU, ZAKARE, DO
SALINAS MALDONADO, OSCAR ,
MD
PULMONARY
CRITICAL CARE
5/1/2017 MEDICINE
DIAGNOSTIC
9/17/2017 RADIOLOGY
8/21/2014
EMERGENCY
8/29/2013 MEDICINE
P3576
N1873
N5378
2/5/2010
8/21/2009
6/15/2012
1/17/2012
1/17/2017 RADIOLOGY
12/15/2010
2/1/2013
11/1/2012
5/1/2012
2/1/2018 PEDIATRICS
Practice City
Registration
Status of
Practice
Texas
State
License
DALLAS
TX
STORM LAKE
IA
ACTIVE
LICENSE
ISSUED
HOUSTON
AMARILLO
HOUSTON
TX
TX
TX
TX
LUBBOCK
RIO GRANDE
CITY
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/9/2009 None
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
9/1/2009 None
6/27/2012 None
1/20/2012 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
1/11/2011 None
2/25/2013 None
11/21/2012 None
N/A
N/A
N/A
11/4/2009 None
3/29/2012 None
N/A
N/A
3/15/2012 None
2/20/2012 None
N/A
N/A
PAIN MEDICINE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
SLEEP MEDICINE
ACTIVE
5/3/2012 None
N/A
ATLANTA
EL PASO
GA
TX
ACTIVE
ACTIVE
10/4/2012 None
8/27/2009 None
N/A
N/A
ALISO VIEJO
GLASGOW
CA
KY
ACTIVE
ACTIVE
9/26/2008 None
11/7/2012 None
N/A
N/A
EDINBURG
TX
ACTIVE
4/19/2010 None
N/A
4/9/2010
SALINAS, CRYSTAL MICHELLE, MD
6/8/2012
6/8/2017 PEDIATRICS
TX
ACTIVE
6/14/2012 None
N/A
P6910
SALINAS, CYNTHIA MAE, MD
6/3/2013
6/3/2018
TX
ACTIVE
7/8/2013 None
N/A
N3285
P3434
SALINAS, JENNIFER SUSAN , MD
SALINAS, MARIELA , MD
5/29/2009
6/1/2012
5/29/2014
6/1/2017
TX
TX
ACTIVE
ACTIVE
6/15/2009 None
6/29/2012 None
N/A
N/A
N2281
P4706
SALOOJA, RAHUL , MD
SALVI, SAMBHITAB SUNIL, MD
2/6/2009
10/15/2012
2/6/2014
10/15/2017
TX
TX
ACTIVE
ACTIVE
3/31/2009 None
10/19/2012 None
N/A
N/A
AUSTIN
SURGICAL CRITICAL
TRAUMATIC SURGERY CARE
MCALLEN
EMERGENCY
MEDICINE
HOUSTON
FAMILY MEDICINE
FAMILY MEDICINE
SAN ANTONIO
EMERGENCY
MEDICINE
HOUSTON
FAMILY MEDICINE
ABILENE
Page 239 of 300
License
Number
P3435
Physician Name
P0670
P6911
P4905
P7345
P5128
P5128
P5128
SALYER, RENA, DO
SALZMAN, CHRISTOPHER
WILLARD VINCENT, MD
SAM, KENNY , DO
SAM, SIBY , MD
SAMBALINGAM, DEVARAJ, MD
SAMBANDAM, BALAGURU , MD
P6717
N1122
SAMBASIVAN, AJAI , MD
SAMBATHKUMAR, LAKSHMI , MD
P5466
SAMEERUDDIN, SYED RAHEEL, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
6/1/2012
6/1/2017 MEDICINE
8/1/2011
6/3/2013
11/15/2012
7/15/2013
12/17/2012
12/17/2012
12/17/2012
5/15/2013
8/29/2008
GENERAL SURGERY
RADIOLOGY
FAMILY MEDICINE
NEONATOLOGY
GENERAL SURGERY
GENERAL SURGERY
GENERAL SURGERY
PHYSICAL MED. &
2/1/2013
10/1/2010
8/1/2016
6/3/2018
11/15/2017
7/15/2018
12/17/2017
12/17/2017
12/17/2017
HAND SURGERY 10/1/2015 PLASTIC SURGERY
ORTHOPEDIC
SURGERY OF THE
4/9/2015 SPINE
N7868
SAMMER, DOUGLAS MICHAEL, MD
N5992
SAMOCHA, YIGAL, MD
N7169
N7746
SAMUELS, MARTEL GEORGE, MD
SAMUELS, TERRI-ANN PATRICIA,
MD
N5993
SAN JUAN, ARMANDO ABAD JR,
MD
4/9/2010
N8982
SAN JUAN, ZINNIA TAN, MD
3/1/2011
P3436
SAN MARTIN, JOSE EDUARDO, MD
6/1/2012
N9124
3/15/2011
N8569
SANA, MOAZZAM MOHAMMAD, DO
SANCHEZ IGLESIAS, GERVASIO A,
MD
1/18/2011
N5994
SANCHEZ, ADOLFO V, MD
4/9/2010
N6637
SANCHEZ, CECILIA RAQUEL, MD
6/4/2010
4/9/2010
7/15/2010
9/15/2010
9/15/2015 UROGYNECOLOGY
OBSTETRICS &
GYNECOLOGICAL
4/9/2015 SURGERY
ENDOCRINOLOGY,
DIABETES AND
3/1/2016 METABOLISM
OBSTETRICS AND
6/1/2017 GYNECOLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SAN ANTONIO TX
HOUSTON
TX
HOSPITALIST
PEDIATRICS
PLASTIC &
RECONSTRUCTIVE
SURGERY
EL PASO
DALLAS
DALLAS
DALLAS
TX
TX
TX
TX
HOUSTON
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
6/1/2012 None
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/25/2011
6/25/2013
11/27/2012
7/18/2013
1/7/2013
1/7/2013
1/7/2013
Disciplinary
Status Date
N/A
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
5/15/2013 None
11/6/2008 None
N/A
N/A
2/1/2013 None
N/A
10/11/2010 None
N/A
DALLAS
TX
ACTIVE
PLANO
TX
ACTIVE
LICENSE
ISSUED
4/19/2010 None
N/A
7/15/2010 None
N/A
ACTIVE
9/28/2010 None
N/A
ACTIVE
5/3/2010 None
N/A
INTERNAL MEDICINE
ACTIVE
3/14/2011 None
N/A
FAMILY PRACTICE
ACTIVE
6/5/2012 None
N/A
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
3/30/2011 None
N/A
1/18/2011 None
N/A
4/9/2010 None
N/A
6/4/2010 None
N/A
HOUSTON
Page 240 of 300
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N7339
SANCHEZ, DIANA E, MD
N1877
N8454
SANCHEZ, FERNANDO LUIS, MD
SANCHEZ, IRAHAM AXEL, MD
P3437
SANCHEZ, KATHRYN TINIO, MD
P0130
SANCHEZ, RICHARD, MD
P0289
SANCHEZ-VELEZ, CATALINA , MD
7/1/2011
7/1/2016 NEPHROLOGY
P3236
5/15/2012
NEUROLOGICAL
5/15/2017 SURGERY
N6984
SANDBERG, DAVID ILAN, MD
SANDER, JAMES CHRISTOPHER,
MD
N8142
SANDERS, BRIAN, MD
P7846
SANDERS, BRIDGET MARIE, MD
8/30/2013
N7869
SANDERS, GEREMY LEE, MD
10/1/2010
N4719
SANDERS, JAMES MITCHELL, MD
11/6/2009
N9292
SANDERS, VIRGINIA MARGARET,
MD
4/1/2011
P2164
SANDERSON, DREW , MD
N6638
N5996
SANDU, CEZAR DANIEL, MD
SANGANA, DINESH KUMAR, MD
N1438
SANGER, MATTHEW KERNAN, MD
P0488
SANGHA, NAVDEEP SINGH, MD
P7701
P0290
SANGHADIA, MUKESH, MD
SANGHAVI, MONIKA, MD
8/2/2010
12/12/2008
1/3/2011
6/1/2012
6/15/2011
7/1/2010
11/15/2010
2/10/2012
6/4/2010
4/9/2010
10/10/2008
7/15/2011
8/15/2013
7/1/2011
INFECTIOUS
12/12/2013 DISEASES
INFECTIOUS
6/1/2017 DISEASES
DIAGNOSTIC
6/15/2016 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE LAREDO
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
JEFFFERSONV
INTERNAL MEDICINE ILLE
IN
7/1/2016 CARDIOLOGY
8/2/2010 None
N/A
ACTIVE
ACTIVE
3/2/2009 None
2/11/2011 None
N/A
N/A
ACTIVE
6/8/2012 None
N/A
IN
ACTIVE
6/20/2011 None
N/A
TX
ACTIVE
8/15/2011 None
N/A
PEDIATRIC SURGERY
(NEUROLOGY)
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
5/16/2012 None
N/A
7/1/2010 None
N/A
2/13/2011 None
N/A
8/30/2013 None
N/A
ACTIVE
10/11/2010 None
N/A
TX
ACTIVE
2/8/2010 None
N/A
PEDIATRICS
SAN ANTONIO TX
ACTIVE
4/28/2011 None
N/A
OTOLARYNGOLOGY
OMAHA
ACTIVE
LICENSE
ISSUED
ACTIVE
2/14/2012 None
N/A
6/4/2010 None
4/27/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
11/20/2008 None
N/A
7/15/2011 None
N/A
8/15/2013 None
7/18/2011 None
N/A
N/A
PEDIATRIC EMER MED
11/15/2015 (PEDS)
COLON AND RECTAL
8/30/2018 SURGERY
GENERAL SURGERY
ANESTHESIOLOGY
VASCULAR
7/15/2016 NEUROLOGY
Disciplinary
Status Date
MARION
7/1/2015 UROLOGY
PEDIATRIC
EMERGENCY
PLASTIC &
RECONSTRUCTIVE
2/10/2017 SURGERY
ORTHOPEDIC
6/4/2015 SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
NE
HOSPITALIST
INTERNAL MEDICINE METAIRIE
LA
PSYCHOSOMATIC
MEDICINE
DALLAS
Page 241 of 300
TX
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
N5997
P6074
Physician Name
SANGUINETTI-COLON, YIRIELIS ,
MD
SANI, SHAHRAM NOROUZI, MD
N7340
SANKA, RATNA KIRAN, MD
N7170
N4720
7/15/2010
11/6/2009
6/8/2012
N9776
SANKA, V S SHANKAR C, MD
SANKAR, SUDHEER KURUP, MD
SANKARA, ISHWARA RAGHU
PRASHANTH, MD
SANKARAPANDIAN,
BALAMURUGAN PONNIAH, MD
SANKHALA, KAMALESH KUMAR,
MD
N7171
SANON, SAURABH , MD
7/15/2010
N5998
SANTACRUZ, JOSE FERNANDO,
MD
4/9/2010
P2062
SANTAROSA, JULIANNE , MD
2/1/2012
L7160
SANTMAN, MARK, MD
P0872
P1018
J8364
N7968
SANTORA, STEPHEN D, MD
SANTOS, ALBERTO MOURA, MD
SANTOS, JOSE SALVADOR, MD
SANTOS, LAMBERT-IAN, MD
P6075
SANTOS, SUSANA, DO
4/1/2013
ORTHOPEDIC
SURGERY OF THE
9/17/2017 SPINE
ORTHOPEDIC
8/26/2016 SURGERY
9/15/2016 NEUROLOGY
EMERGENCY
4/1/2018 MEDICINE
N7341
SANUSI, LUKMAN ADESOLA, MD
8/2/2010
K4229
SAPERSTEIN, DAVID SCOTT, MD
10/17/2011
P3439
P7200
SAQIB, NAVEED USMAN, MD
SARAO, RAVJOT SINGH, MD
6/1/2012
7/1/2013
P1138
SARASWAT, SHANTANU, MD
10/3/2011
P3577
N4721
4/9/2010
4/1/2013
4/9/2015 PEDIATRICS
8/2/2010
8/2/2015 NEUROLOGY
11/6/2009
5/16/2011
9/17/2012
8/26/2011
9/15/2011
4/2/2012
10/15/2010
Registration
Status of
Secondary Specialty
Practice
Texas
(Self-Designated)
Practice City
State
License
LICENSE
ISSUED
INTERNAL MEDICINE WASHINGTON DC
ACTIVE
NEUROMUSCULAR
DISEASE
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE CINCINNATI
OH
ACTIVE
CRITICAL CARE
MEDICINE
DALLAS
TX
ACTIVE
HEMATOLOGY/ONCOL
5/16/2016 OGY
PULMONARY
CRITICAL CARE
4/9/2015 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/9/2010 None
4/9/2013 None
N/A
N/A
8/5/2010 None
N/A
7/15/2010 None
12/7/2009 None
N/A
N/A
6/11/2012 None
N/A
11/13/2009 None
N/A
ACTIVE
LICENSE
ISSUED
5/18/2011 None
N/A
7/15/2010 None
N/A
ACTIVE
TX
ACTIVE
4/16/2010 None
N/A
COSMETIC SURGERY DALLAS
TX
ACTIVE
2/3/2012 None
N/A
10/5/2012 None
N/A
ORTHOPEDIC
SURGERY
ROUND ROCK TX
SLEEP MEDICINE
SUNRISE
HOUSTON
FL
TX
SAN ANTONIO TX
OBSTETRICS AND
GYNECOLOGY
NEUROMUSCULAR
DISEASE
BENBROOK
TX
HOSPITALIST
SAN ANTONIO TX
PULMONARY
CRITICAL CARE
SUNCITY
10/3/2016 MEDICINE
WEST
AZ
Page 242 of 300
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
8/26/2011
12/8/2011
4/5/2012
10/22/2010
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/30/2013 None
N/A
8/2/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
10/27/2011 None
N/A
6/1/2012 None
8/23/2013 None
N/A
N/A
ACTIVE
10/20/2011 None
N/A
License
Number
P0490
Physician Name
N5380
SARATA, JEFFREY D, DO
SARAVANAN, SIRUMUGAI
MUTHUSWAMY , MD
P2165
SARDANA, JASMINE SAMUEL, MD
N1127
L1732
SARDINI, MUSTAFA , MD
SARKAR, DEEPAK RANJAN, MD
P6718
SARKAR, KUNAL, MD
N8455
P5467
P1403
P7201
SARMA, DEBA, MD
SARMIENTO, JORGE LUIS, MD
SAROLIA, SEJAL PRAVIN, MD
SARRAFF, MICHELLE ANN, MD
P4811
SARTIN, MELISSA DAWN, MD
N7747
P4707
SASA, GHADIR SULEIMAN, MD
SATANI, DHAVAL D, MD
P0929
N3290
SATCHO, HONORE, MD
SATISH, NISHA , MD
P4906
SATTAR, AMBREEN, MD
N1880
P2921
N2778
SATTAR, BIBI TASLEYMA, DO
SAUCIER, JESSICA MARIE, MD
SAUL-SEHY, CHERYL LYNN, MD
P3441
P4813
N4069
SAUTNER, JEREMY SCOTT, MD
SAVAGE, ADAM MICHAEL, MD
SAVU, MICHELLE K, MD
N6001
SAW, ANDREW M, MD
N5383
SAWHNEY, RAJA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
EMERGENCY
7/15/2011
7/15/2016 MEDICINE
SAN ANTONIO
CARDIOVASCULAR
2/5/2010
2/5/2015 DISEASES
INTERNAL MEDICINE
OCCUPATIONAL
2/10/2012
2/10/2017 MEDICINE
GENERAL PRACTICE
NACOGDOCH
8/29/2008
ES
11/15/2010
RIPLEY
INTERVENTIONAL
5/15/2013
CARDIOLOGY
COLON AND RECTAL
1/3/2011
1/3/2016 SURGERY
GENERAL SURGERY
2/1/2013
2/1/2018 RADIOLOGY
EL PASO
11/4/2011
7/1/2013
7/1/2018 PEDIATRICS
SAN ANGELO
EMERGENCY
11/1/2012
11/1/2017 MEDICINE
DALLAS
PEDIATRIC
HEMATOLOGY/ONCOL
9/15/2010
9/15/2015 OGY
HOUSTON
10/15/2012
INTERNAL MEDICINE BINGHAMTON
OBSTETRICS AND
9/1/2011
9/1/2016 GYNECOLOGY
5/29/2009
DALLAS
INTERVENTIONAL
DIAGNOSTIC
11/15/2012
RADIOLOGY
DETROIT
FAMILY
12/12/2008
PRACTICE/OMM
MIRAMAR
4/13/2012
4/3/2009
4/3/2014 PEDIATRICS
TEXARKANA
EMERGENCY
WICHITA
6/1/2012
6/1/2017 MEDICINE
FALLS
11/1/2012
PAIN MANAGEMENT TEMPLE
8/21/2009
SAN ANTONIO
ELECTRODIAGNOSTI
4/9/2010
4/9/2015 NEUROLOGY
C MEDICINE
TYLER
OTOLARYN & FACIAL
2/5/2010
Page 243 of 300
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
8/16/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
2/13/2012 None
N/A
TX
WV
ACTIVE
ACTIVE
9/17/2008 None
1/19/2011 None
N/A
N/A
5/16/2013 None
N/A
TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
1/3/2011
2/7/2013
11/8/2011
7/9/2013
None
None
None
None
N/A
N/A
N/A
N/A
TX
ACTIVE
11/6/2012 None
N/A
TX
NY
10/4/2010 None
1/9/2013 None
N/A
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
9/1/2011 None
6/12/2009 None
N/A
N/A
MI
ACTIVE
11/26/2012 None
N/A
FL
TX
TX
ACTIVE
ACTIVE
ACTIVE
12/18/2008 None
4/24/2012 None
4/10/2009 None
N/A
N/A
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
6/8/2012 None
11/6/2012 None
9/15/2009 None
N/A
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
4/26/2010 None
N/A
2/5/2010 None
N/A
License
Number
N8144
P4509
P7031
P5468
Physician Name
SAWHNEY, SUMAN KUMAR, MD
SAWICKI, ANGELINE KATHARINE,
MD
SAWYERR, THOMAS NEMAHUN,
MD
SAYANI, JAIRAJ, MD
N7871
SAYEED, JAWEED, MD
P1489
SAYEGH, GILBERT GEORGE, MD
P7032
N9294
SAYIED, TAUSIF, MD
SCANLAN, LYNNE, DO
SCHAEFER, STEPHANIE MCLEISH,
MD
N4727
P2782
dicaid
dicaid
Agreement
End Date
Designated)
9/17/2012
TEMPLE
6/14/2013
2/1/2013
10/1/2010
6/14/2013
4/1/2011
OBSTETRICS AND
PULMONARY
CRITICAL CARE
6/14/2018 MEDICINE
11/6/2009
11/15/2011
4/2/2012
N6641
N9410
N8346
SCHIEMENZ, APRIL ANN, MD
SCHIRMER, JEREMY ALLEN, MD
4/8/2011
12/15/2010
6/4/2015 PEDIATRICS
OBSTETRICS AND
4/8/2016 GYNECOLOGY
N8347
SCHLAGER, DAVID S, MD
12/15/2010
P4817
SCHLEGEL, CHELSEA ROSE, MD
N4074
SCHLOMER, BRUCE JEREMY, MD
SCHMALBACH, CECELIA
ELIZABETH , MD
H3519
SCHMER, VERONICA R E, MD
N6986
SCHMICKRATH, SARAH JEAN, MD
P3442
N8241
SCHMID, KRISTIN LEA, MD
SCHMIT, DAVID ROGER, MD
Secondary Specialty
(Self-Designated)
Practice City
GERIATRIC
MEDICINE (INTERNAL
MED)
STONY POINT NY
11/15/2010
SCHEFLER, AMY CLAIRE, MD
SCHEIDEMAN, ERIN ELIZABETH,
MD
P6262
Registration
Status of
Practice
Texas
State
License
6/4/2010
4/12/2013
11/1/2012
8/21/2009
3/1/2012
7/1/2010
6/1/2012
12/1/2010
INTERVENTIONAL
CARDIOLOGY
Disciplinary
Status Date
ACTIVE
12/13/2010 None
N/A
TX
ACTIVE
9/19/2012 None
N/A
CORSICANA
FREMONT
TX
OH
ACTIVE
ACTIVE
7/16/2013 None
2/15/2013 None
N/A
N/A
AURORA
IL
ACTIVE
10/11/2010 None
N/A
WHARTON
TX
ACTIVE
11/21/2011 None
N/A
TX
LICENSE
ISSUED
ACTIVE
6/14/2013 None
4/26/2011 None
N/A
N/A
TX
ACTIVE
11/16/2009 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
4/3/2012 None
N/A
6/4/2010 None
N/A
4/8/2011 None
2/14/2011 None
N/A
N/A
12/31/2010 None
N/A
4/12/2013 None
N/A
SLEEP MEDICINE
LEANDER
LACKLAND
GEORGETOW
N
TX
ALLERGY AND
IMMUNOLOGY
HEAD AND NECK
SURGERY
PEDIATRICS,
3/1/2017 CARDIOLOGY
EMERGENCY
7/1/2015 MEDICINE
OPHTHALMOLOGY 6/1/2017 OPHTHALMOLOGY
GLAUCOMA
Page 244 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN
FRANCISCO
ACTIVE
LICENSE
ISSUED
CA
ACTIVE
1/9/2013 None
N/A
SAN ANTONIO TX
ACTIVE
8/31/2009 None
N/A
ACTIVE
4/9/2012 None
N/A
TX
ACTIVE
7/16/2010 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
6/4/2012 None
12/17/2010 None
N/A
N/A
CORPUS
CHRISTI
License
Number
N5515
N6987
Physician Name
SCHNIEDERJAN, MATTHEW BLEU,
MD
SCHOCHLER, AMY LEANN, DO
N5384
SCHOOLER, KEVIN PATRICK, MD
P1223
P7563
P0672
SCHROEDER, ROBERT EUGENE,
MD
SCHUMAN MCCOY, JEANNINE
MICHELLE, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/9/2010
7/1/2010
2/5/2010
10/17/2011
8/1/2013
N1885
SCHURMANN, PAUL ANTONIO, MD
SCHWARCZ, RICARDO MARTIN,
MD
12/12/2008
P6263
SCHWARTZ, JOANNA DENISE, MD
4/12/2013
P1591
SCHWECHTEN, KEVIN J, MD
SCHWEGLER, ERIKA HERNANDEZ,
MD
SCHWIEGER, JENNIFER
MICHELLE, MD
SCIALDONE, ANTHONY MICHAEL,
MD
12/1/2011
5/29/2009
P2359
N4731
SCIRTO, KIRK ANTHONY , MD
SCOGGINS, MARION ELIZABETH,
MD
SCOTT, LAUREL ALLISON, MD
H9710
SCOTT, PHILIP L, DO
12/12/2008
N9641
SCOTT, SARA B, MD
5/2/2011
P4510
SCRIBNER, JAMES THOMAS, MD
SCROGGINS, JOHN WILLIAM JR,
MD
P2358
P0874
P2063
N3296
N6988
8/1/2011
3/1/2012
8/26/2011
2/1/2012
3/1/2012
11/6/2009
9/17/2012
7/1/2010
PEDIATRIC CRITICAL
Secondary Specialty
(Self-Designated)
DALHART
OROFINO
TX
ID
PEDIATRICS
PEDIATRICS,
8/1/2018 CARDIOLOGY
PEDIATRICS
PULMONARY
12/12/2013 DISEASES
PEDIATRIC
EMERGENCY
Practice City
Registration
Status of
Practice
Texas
State
License
AUSTIN
TX
Disciplinary
Status Date
5/3/2010 None
7/5/2010 None
N/A
N/A
2/5/2010 None
N/A
10/17/2011 None
N/A
ACTIVE
8/12/2013 None
N/A
ACTIVE
8/15/2011 None
N/A
LICENSE
ISSUED
CRITICAL CARE
MEDICINE (IM)
HARLINGEN
TX
ACTIVE
12/22/2008 None
N/A
PEDIATRICS
AUSTIN
TX
ACTIVE
4/25/2013 None
N/A
FAMILY MEDICINE
CORINTH
MS
ACTIVE
1/4/2012 None
N/A
4/10/2012 None
N/A
8/26/2011 None
N/A
2/1/2012 None
N/A
8/27/2009 None
N/A
EMERGENCY
8/26/2016 MEDICINE
EMERGENCY
2/1/2017 MEDICINE
DIAGNOSTIC
3/1/2017 RADIOLOGY
CHILD AND
ADOLESCENT
EMERGENCY
5/2/2016 MEDICINE
EMERGENCY
9/17/2017 MEDICINE
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
PSYCHIATRY
HOUSTON
SUGAR LAND
TX
TX
ACTIVE
ACTIVE
3/5/2012 None
11/12/2009 None
N/A
N/A
TEMPLE
TX
ACTIVE
1/9/2009 None
N/A
BALTIMORE
MD
ACTIVE
5/30/2011 None
N/A
ACTIVE
LICENSE
ISSUED
9/21/2012 None
N/A
7/1/2010 None
N/A
FORT WORTH TX
Page 245 of 300
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P3578
SCRUGGS, JESSICA M, MD
6/8/2012
N6989
SEAWELL, MICHAEL ROBERT, MD
7/1/2010
P1020
SECH, CANDICE KAY, MD
H2964
Secondary Specialty
(Self-Designated)
DERMATOLOGIC
SURGERY
Practice City
7/1/2010 None
N/A
9/21/2011 None
N/A
9/5/2008 None
N/A
6/15/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/25/2012 None
3/5/2012 None
N/A
N/A
2/15/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/3/2012 None
7/26/2010 None
N/A
N/A
2/4/2011 None
N/A
FORT WORTH TX
ACTIVE
6/13/2012 None
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
7/12/2010 None
8/10/2009 None
N/A
N/A
ROSWELL
NM
ACTIVE
12/22/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
5/19/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
1/27/2010 None
11/19/2009 None
5/24/2012 None
N/A
N/A
N/A
6/3/2011 None
N/A
CARDIOLOGY
SECREST, CHARLES LLOYD, MD
8/29/2008
8/29/2013 UROLOGY
UROLOGIC SURGERY JACKSON
P0134
SEE, CRAIG STEPHEN, MD
6/15/2011
P3581
P2361
6/8/2012
3/1/2012
N8849
SEERY, THOMAS J, MD
SEGARS, DOUGLAS , DO
SEGU, VENKATESH BABU
GOKULAN, MD
2/15/2011
PEDIATRICS,
6/8/2017 CARDIOLOGY
3/1/2017 PSYCHIATRY
EMERGENCY
2/15/2016 MEDICAL SERVICES
P3072
N6990
SEHGAL, MONICA, MD
SEHGAL, RAJ TEK, MD
5/1/2012
7/1/2010
OBSTETRICS AND
5/1/2017 GYNECOLOGY
N8721
SEHGAL, SUPRIYA, MD
2/4/2011
P3582
SEIDEN, JASON ANDREW, MD
6/8/2012
N6991
N3298
SEILER, STEPHEN JACOB, MD
SEIN, TIN , MD
7/1/2010
5/29/2009
P1693
SEIVWRIGHT, TRUDY LECEIN, MD
N9778
SEJPAL, DIVYESH VASANT, MD
N6008
SELLARDS, ROBERT ALLEN, MD
N4733
N4734
P3241
SELOUAN, ROGER RAYMOND, MD
SEMONES, KAREN L , MD
SENGUPTA, PIYALI DAS, MD
N9954
SENS, ASHLEY E, MD
12/15/2011
5/16/2011
4/9/2010
11/6/2009
11/6/2009
5/15/2012
6/3/2011
OBSTETRICS AND
GASTROENTEROLOG
5/16/2016 Y
ORTHOPEDIC
4/9/2015 SURGERY
11/6/2014 RADIOLOGY
PLANO
TX
ACTIVE
MS
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
FORT WORTH TX
INTERNAL MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
MARSHALL
TX
HOSPITALIST
SAN ANTONIO TX
DALLAS
OBSTETRICS &
GYNECOLOGICAL
SURGERY
TX
RADIOLOGY
6/3/2016 PEDIATRICS
Page 246 of 300
Disciplinary
Status Date
N/A
9/15/2011
SLEEP MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
6/8/2012 None
INTERVENTIONAL
PULMONARY
CRITICAL CARE
6/8/2017 MEDICINE
DIAGNOSTIC
7/1/2015 RADIOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
OLYMPIA
DICKINSON
TX
WA
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
INFECTIOUS
11/1/2012
11/1/2017 DISEASES
11/4/2011
11/4/2016 RADIOLOGY
ORTHOPEDIC
12/12/2008
12/12/2013 SURGERY
P4819
P1404
SERIBURI, VIMON, MD
SERLIN, SCOTT BENJAMIN, MD
N1887
SEROYER, SHANE THOMAS, MD
P2362
SERRETTE, JUSTIN MICHAEL, MD
P4709
SESHADRI, SHESHASHREE, MD
N2788
SETHI, MANU , MD
4/3/2009
N6648
SETHI, MUNAZZA SAJJAD, MD
6/4/2010
P1695
SETIAWAN, CHRISTOPHER TAN,
MD
P5571
SEUNGDAMRONG, JASON, MD
N9295
P0493
SEWELL, ADAM LEE, MD
SEWELL, STEVEN KENNETH, MD
4/1/2011
7/15/2011
N6649
SEYMOUR, ELIZABETH RUTH, MD
6/4/2010
3/1/2012
3/1/2017 PEDIATRICS
10/15/2012
12/15/2011
2/8/2013
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE
RADIOLOGY
HOUSTON
SPORTS MEDICINE
(ORTH SURG)
ARLINGTON
GALVESTON
CORPUS
CHRISTI
EMERGENCY
2/8/2018 MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
HOUSTON
GERIATRIC
MEDICINE (INTERNAL
MED)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
SLEEP MEDICINE
Registration
Status of
Practice
Texas
State
License
SEZGINIS, ARAL , MD
9/15/2011
PHYSICAL MED. &
N8850
SHAD, ASFA YOUSAF, DO
2/15/2011
2/15/2016 NEUROLOGY
P3073
SHADDIX, KYLE KIT, MD
5/1/2012
N5388
SHAFER, KERI MARIE, MD
2/5/2010
N9126
N3300
P5722
SHAFI, NADIYA BABAR, MD
SHAFI, NAHID , MD
SHAFIE, EL SHERIF OMAR, MD
3/15/2011
5/29/2009
3/1/2013
P3074
SHAFII, ALEXIS EDWARD, MD
5/1/2012
3/15/2016 PATHOLOGY
CARDIOVASCULAR
5/1/2017 SURGERY
ACTIVE
ACTIVE
12/28/2012 None
12/8/2011 None
N/A
N/A
TX
ACTIVE
3/10/2009 None
N/A
TX
ACTIVE
3/9/2012 None
N/A
TX
ACTIVE
10/18/2012 None
N/A
TX
ACTIVE
4/21/2009 None
N/A
LICENSE
ISSUED
6/4/2010 None
N/A
ACTIVE
1/6/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/18/2013 None
N/A
4/1/2011 None
8/1/2011 None
N/A
N/A
6/4/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
11/30/2011 None
N/A
2/15/2011 None
N/A
5/1/2012 None
N/A
2/5/2010 None
N/A
3/15/2011 None
6/16/2009 None
3/21/2013 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
5/25/2012 None
N/A
6/4/2010 None
N/A
DALLAS
TX
LEESVILLE
LA
N6650
SHAFIK, MARK SALEH, MD
6/4/2010
WACO
SUGAR LAND
Page 247 of 300
Disciplinary
Status Date
TX
PAIN
MANAGEMENT/REHA
B MED
P1021
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N9643
SHAH, AJAY KUMAR, MD
P7205
P0494
P7704
SHAH, AJITA RAJANIKANT, MD
SHAH, ARATHI APURVA, MD
SHAH, AVNI ASHOK, DO
7/1/2013
7/15/2011
8/15/2013
N1888
P5131
P5131
P5131
SHAH, DARSHAN PRAVIN, MD
SHAH, GOPI BIPIN, MD
12/12/2008
12/17/2012
12/17/2012
12/17/2012
P1696
SHAH, HEMALI , MD
12/15/2011
TM00474 SHAH, HEMANT BHARAT, MD
P3242
SHAH, JAY NARESH, DO
N8983
SHAH, KEJAL RINOO, MD
9/15/2011
5/15/2012
3/1/2011
P6519
SHAH, MANAN SHIRISHKUMAR, MD
N7348
P3447
N1889
SHAH, MEHA, MD
SHAH, NAYNA VISHAL, MD
SHAH, NEERAJ BHAGWAN, MD
5/2/2011
EMERGENCY
7/1/2018 MEDICINE
12/12/2013
12/17/2017
12/17/2017
12/17/2017
GENERAL PRACTICE
OTOLARYNGOLOGY
OTOLARYNGOLOGY
OTOLARYNGOLOGY
EMERGENCY
12/15/2016 MEDICINE
9/15/2016 RADIOLOGY
AUSTIN
TX
SAN ANTONIO TX
AUSTIN
TX
GENERAL PRACTICE DALLAS
NASHVILLE
NASHVILLE
NASHVILLE
EMERGENCY
MEDICINE
HOUSTON
8/2/2010
6/1/2012
12/12/2008
ORTHOPEDIC
SURGERY OF THE
2/4/2016 SPINE
N8722
N4084
SHAH, NEIL DILIP, MD
SHAH, NINA , DO
N6652
SHAH, RAJVEE MANOJ, MD
N7874
SHAH, RONAK VINOD, DO
10/1/2010
J6239
SHAH, SAQIB MIAN, MD
3/15/2012
6/4/2015 RADIOLOGY
AEROSPACE
10/1/2015 MEDICINE
EMERGENCY
3/15/2017 MEDICINE
P4820
P5724
SHAH, SHILPAN SATISH, MD
SHAH, SHREYANSH DINESH, MD
11/1/2012
3/1/2013
3/1/2018 NEUROLOGY
N2794
N6993
SHAH, SWATI RUCHIR, MD
SHAH, TEJAL BIPIN, MD
4/3/2009
7/1/2010
6/4/2010
Practice City
MILWAUKEE
5/1/2013
2/4/2011
8/21/2009
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
HOSPITALIST
ACTIVE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
5/2/2011 None
N/A
7/10/2013 None
7/20/2011 None
8/29/2013 None
N/A
N/A
N/A
TX
TN
TN
TN
ACTIVE
ACTIVE
ACTIVE
ACTIVE
2/2/2009
12/21/2012
12/21/2012
12/21/2012
None
None
None
None
N/A
N/A
N/A
N/A
TX
ACTIVE
12/26/2011 None
N/A
WI
ACTIVE
ACTIVE
ACTIVE
10/11/2011 None
6/19/2012 None
3/28/2011 None
N/A
N/A
N/A
5/17/2013 None
N/A
8/2/2010 None
6/11/2012 None
3/13/2009 None
N/A
N/A
N/A
2/4/2011 None
9/3/2009 None
N/A
N/A
6/4/2010 None
N/A
10/11/2010 None
N/A
TX
ODESSA
TX
URBANA
DALLAS
IL
TX
ORTHOPEDIC
SURGERY
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
PEDIATRIC
RADIOLOGY
TX
ACTIVE
INTERNAL MEDICINE MESQUITE
HEMATOLOGY/ONCO
LOGY
HOUSTON
GERIATRIC
MEDICINE (INTERNAL
MED)
SAN MATEO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
3/20/2012 None
N/A
11/1/2012 None
3/5/2013 None
N/A
N/A
ACTIVE
ACTIVE
6/29/2009 None
7/6/2010 None
N/A
N/A
Page 248 of 300
TX
CA
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N6654
SHAH, ULKA KISHOR-NIRAJ, MD
P0791
P5132
P5132
P5132
SHAH, UMANG HASMUKHLAL, MD
SHAH, ZAINAB ZAHRA, MD
N6994
SHAHID, NAHEED AHMAD, MD
N7491
SHAHIDI, HASSAN , DO
8/16/2010
N5390
SHAHIN, ISLAM ALY, MD
2/5/2010
P7853
SHAIKH, AISHA , MD
N8723
SHAKE, JAY G, MD
P1022
N4085
SHAKER, ADEL, MD
SHAKIL, JAWAIRIA , MD
P5134
SHAKIR, AHMED RAZA, MD
12/17/2012
P5134
12/17/2012
P5134
12/17/2012
SURGICAL CRITICAL
2/4/2016 CARE
ANATOMIC
PATHOLOGY & LAB
9/15/2016 MEDICINE
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
P5891
SHAKIR, HUZAIFA ABBAS, MD
3/15/2013
CARDIOVASCULAR
3/15/2018 SURGERY
P3448
SHALHUB, SHERENE, MD
P7707
SHAMA, LEAH KATHERINE, DO
K1671
SHAMAA, SHERIF MOHAMED, MD
2/5/2010
P2786
SHANI, RAJ HARRY, MD
4/2/2012
P1406
SHANKER, JASON ANDREW, DO
6/4/2010
8/15/2011
12/17/2012
12/17/2012
12/17/2012
7/1/2010
8/30/2013
2/4/2011
9/15/2011
8/21/2009
6/1/2012
8/15/2013
11/4/2011
6/4/2015 PEDIATRICS
INTERVENTIONAL
Secondary Specialty
(Self-Designated)
CARDIOLOGY
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
EMERGENCY
8/16/2015 MEDICINE
Practice City
SAN ANTONIO
WICHITA
WICHITA
WICHITA
DALLAS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
KS
KS
KS
FORENSIC
PATHOLOGY
JACKSON
MIDLAND
GENERAL VASCULAR
SURGERY
PASSAIC
7/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/19/2010 None
N/A
2/5/2010 None
N/A
8/30/2013 None
N/A
TX
ACTIVE
2/14/2011 None
N/A
MS
TX
ACTIVE
ACTIVE
9/20/2011 None
8/27/2009 None
N/A
N/A
ACTIVE
1/4/2013 None
N/A
ACTIVE
1/4/2013 None
N/A
ACTIVE
1/4/2013 None
N/A
NJ
ACTIVE
3/21/2013 None
N/A
TX
ACTIVE
6/12/2012 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
8/28/2013 None
N/A
2/5/2010 None
N/A
4/2/2012 None
N/A
11/10/2011 None
N/A
FAMILY
HOUSTON
ORTHOPEDIC
4/2/2017 SURGERY
EMERGENCY
11/4/2016 MEDICINE
Page 249 of 300
GREENSBURG IN
SAN ANTONIO TX
CORPUS
CHRISTI
TX
ACTIVE
8/22/2011
12/24/2012
12/24/2012
12/24/2012
N/A
N/A
N/A
N/A
N/A
2/5/2015 RADIOLOGY
THORACIC SURGERY TEMPLE
6/4/2010 None
Disciplinary
Status Date
None
None
None
None
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
P7206
SHANKER, SHRUTI, DO
N6995
SHANLEY, LETICIA AURORA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
7/1/2013
7/1/2018 PEDIATRICS
7/1/2010
7/1/2015 PEDIATRICS
PEDIATRICS,
12/15/2010
PEDIATRICS
INTERVENTIONAL
8/26/2011
CARDIOLOGY
7/15/2013
SURGICAL
5/29/2009
5/29/2014 ONCOLOGY
GENERAL SURGERY
3/15/2012
INTERNAL MEDICINE
4/9/2010
PEDIATRIC CRITICAL
6/3/2013
PEDIATRIC
7/1/2010
3/15/2012
EMERGENCY
2/5/2010
2/5/2015 MEDICINE
RADIATION
4/3/2009
4/3/2014 ONCOLOGY
NEUROMUSCULAR
7/1/2013
7/1/2018 DISEASE
NEUROLOGY
8/30/2013
8/30/2018 NEUROLOGY
12/1/2011
INTERNAL MEDICINE
VASCULAR AND
INTERVENTIONAL
DIAGNOSTIC
10/15/2012
RADIOLOGY
EMERGENCY
3/15/2011
3/15/2016 MEDICINE
GERIATRICS 6/3/2011
2/1/2012
PAIN MANAGEMENT
N8348
SHAPIRO, ALLAN JAMES, MD
P0876
P7350
SHAQRA, HUSSEIN ABDO, MD
SHARDA, ROHIT, MD
N3303
P2521
N6013
SHARIF, SUHAIL , MD
SHARMA, AMIT, MD
SHARMA, ISHITA, MD
P6915
SHARMA, KAMAL PRASAD, MD
N6997
P2522
SHARMA, PREETI BHATIA, MD
SHARMA, SUJATA, MD
N5394
SHARMA, VIMI, DO
N2799
SHARP, HADLEY JEAN, MD
P7207
P7854
P1593
SHARP, LYDIA JANE, MD
SHARRIEF, ANJAIL ZARINAH, MD
SHASTRI, SHANI, MD
P4711
SHAW, CATHRYN JOHNSON, MD
N9127
SHEEHAN, PAUL, MD
N9956
P2064
SHEIKH, SHAZIA SHAFEEQ, MD
SHEIKH, SUFYAN AHMAD, MD
N5396
SHEKHANI, SHAHID , MD
P3583
N1893
SHELLENBERGER, JEFFRY, MD
SHELTON, KEVIN JAMES, MD
N4090
SHEN, LUKE YU-PING, MD
8/21/2009
P0496
SHEPARD, DANIEL PAUL, MD
7/15/2011
2/5/2010
6/8/2012
12/12/2008
Registration
Status of
Practice
Texas
Practice City
State
License
SAN ANTONIO TX
ACTIVE
DALLAS
TX
ACTIVE
SPRINGFIELD MO
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/12/2013 None
N/A
7/27/2010 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
FT. WORTH
MERIDIAN
ALEXANDRIA
TX
ID
LA
ACTIVE
ACTIVE
ACTIVE
6/5/2009 None
3/26/2012 None
4/29/2010 None
N/A
N/A
N/A
ACTIVE
6/7/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/16/2010 None
3/23/2012 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
5/15/2009 None
N/A
DALLAS
TX
12/22/2010 None
N/A
8/26/2011 None
7/16/2013 None
N/A
N/A
DALLAS
HOUSTON
DALLAS
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/8/2013 None
9/4/2013 None
12/7/2011 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
10/26/2012 None
N/A
MEMPHIS
TN
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/28/2011 None
N/A
6/3/2011 None
2/7/2012 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
ACTIVE
6/12/2012 None
12/23/2008 None
N/A
N/A
ACTIVE
9/30/2009 None
N/A
ACTIVE
8/2/2011 None
N/A
LOWELL
MA
2/5/2015 ONCOLOGY
INTERNAL MEDICINE
EMERGENCY
6/8/2017 MEDICINE
CELINA
TX
TRANSPLANT
8/21/2014 SURGERY
SANTA MARIA CA
Page 250 of 300
License
Number
N6017
Physician Name
SHEPHERD, LONI LYNN, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/9/2010
11/30/2012
4/9/2015 PEDIATRICS
DIAGNOSTIC
P5002
SHEPHERD, SUZANNE MARIE, MD
N6018
SHEPPARD, SHAINA MONIC, MD
N8853
SHERMAN, VICTOR LEE, MD
2/15/2011
P0673
8/1/2011
N7875
SHERPA, TSERING, MD
SHERRILL, JULIA KRISTINA
CATHERINE, MD
10/1/2010
P1817
N4093
N4094
N4095
N6020
SHERWOOD, SCOT HAMILTON, MD
SHESHADRI, AJAY, MD
SHETGIRI, RASHMI , MD
SHETH, MILAN KIRAN , MD
SHI, ANN ANG, MD
1/2/2012
8/21/2009
8/21/2009
8/21/2009
4/9/2010
1/2/2017
8/21/2014
8/21/2014
8/21/2014
4/9/2015
P7208
SHI, ZHENG, MD
N4745
SHIBER, JOSEPH R, MD
11/6/2009
P0137
N9957
SHIBLI, ADEEL BASIT, MD
SHIBLI, UROOJ BASIT, MD
6/15/2011
6/3/2011
N5398
SHIELDS, STEPHEN DAMIEN, MD
4/9/2010
7/1/2013
2/5/2010
P1493
SHIFFLETTE, VANESSA KIANA, MD
11/15/2011
N8458
SHILOH, MICHAEL, MD
1/3/2011
P0932
SHINDE, ANITA BHAGWAN, MD
9/1/2011
N8854
2/15/2011
N6998
P5726
SHINWARI, JAVED KHAN, MD
SHIPCHANDLER, ABEEZAR TAMIM,
MD
SHIRLEY, YOUNG SHIL, MD
N8572
SHIRVANI, SHERVIN , MD
1/18/2011
7/1/2010
3/1/2013
Secondary Specialty
(Self-Designated)
Practice City
MUSCULOSKELETAL
RADIOLOGY
BIRMINGHAM
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
AL
HOSPITALIST
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
FAMILY PRACTICE
ACTIVE
EMERGENCY
2/15/2016 MEDICINE
RADIOLOGY
INTERNAL MEDICINE
PEDIATRICS
ANESTHESIOLOGY
RADIOLOGY
RADIATION
7/1/2018 ONCOLOGY
CRITICAL CARE
11/6/2014 MEDICINE
EMERGENCY
2/5/2015 MEDICINE
INFECTIOUS
1/3/2016 DISEASES
DALLAS
HOUSTON
HOUSTON
INTERNAL MED EMERGENCY MED
PULMONARY
CRITICAL CARE
MEDICINE
TX
TX
TX
Disciplinary
Status Date
4/9/2010 None
N/A
12/6/2012 None
N/A
4/9/2010 None
N/A
2/15/2011 None
N/A
8/1/2011 None
N/A
10/12/2010 None
N/A
1/13/2012
9/7/2009
8/26/2009
10/1/2009
4/14/2010
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
7/2/2013 None
N/A
HOUSTON
TX
ACTIVE
1/22/2010 None
N/A
MESQUITE
MESQUITE
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
6/20/2011 None
6/20/2011 None
N/A
N/A
2/5/2010 None
N/A
11/24/2011 None
N/A
1/31/2011 None
N/A
9/1/2011 None
N/A
2/15/2011 None
N/A
TRAUMATIC
SURGERY
ACTIVE
TX
HEMATOLOGY/ONCOL
2/15/2016 OGY
INTERNAL MEDICINE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
INTERNAL MEDICINE PLANO
HOSPITALIST
EL PASO
RADIATION
1/18/2016 INTERNAL MEDICINE ONCOLOGY
HOUSTON
Page 251 of 300
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
TX
ACTIVE
ACTIVE
7/5/2010 None
3/4/2013 None
N/A
N/A
TX
ACTIVE
1/27/2011 None
N/A
License
Number
P2924
Physician Name
SHITTA-BEY, ABIOLA LATIFAT, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/13/2012
N6021
SHIVES, JASON LEE, MD
4/9/2010
P0878
N6999
N1142
P2527
SHLAMOVITZ, GIL ZVI, MD
SHOETAN, CHARLES, MD
SHOOK, RYAN SETH, MD
SHORE, BRAD LEON, MD
8/26/2011
7/1/2010
8/29/2008
3/15/2012
P5237
P7855
SHORT, TRACEE C, MD
SHPARAGO, NEAL IRA, DO
1/4/2013
8/30/2013
H8837
SHREEVE, DANIEL FREDERICK,
MD
8/15/2013
P4712
SHRESTHA, SHREE OM, MD
P0294
SHRIVASTAVA, ANJU , MD
N1143
SHUFELDT, JOHN , MD
P4713
N9300
SHUHATOVICH, YEVGENY, DO
SHUKLA, MANAN S, MD
N9129
SHUKLA, PRANAV B, MD
N6023
10/15/2012
7/1/2011
8/29/2008
10/15/2012
4/1/2011
Practice City
EMERGENCY
8/26/2016 MEDICINE
CHILD AND
ADOLESCENT
EMERGENCY
8/29/2013 MEDICINE
3/15/2011
10/15/2017 HAND SURGERY
EMERGENCY
3/15/2016 MEDICINE
SHULKIN, ZEV ANDREW, MD
4/9/2010
N9958
SHULL, JAMES HERBERT JR, MD
6/3/2011
N9486
P4714
SHULMAN, ANDREW IRA, MD
SHULMAN, JOSHUA M, MD
P7351
SHUM, JONATHAN, MD
7/15/2013
PEDIATRIC
ORAL &
MAXILLOFACIAL
7/15/2018 SURGERY
P1407
N8460
SHUMWAY, PRESTON WAYNE, DO
SI, QIUSHENG , MD
11/4/2011
1/3/2011
4/15/2011
10/15/2012
Secondary Specialty
(Self-Designated)
EMERGENCY
11/4/2016 MEDICINE
1/3/2016 PATHOLOGY
SUGARLAND
COSMETIC SURGERY
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
URGENT CARE
MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
GEORGETOW
N
TX
WINDSOR
MO
NEUROLOGY
HEAD AND NECK
SURGERY
OSTEO
MANIPULATIVE
MEDICINE
Page 252 of 300
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
4/13/2012 None
N/A
4/9/2010 None
N/A
8/26/2011
7/19/2010
10/13/2008
4/11/2012
None
None
None
None
N/A
N/A
N/A
N/A
1/4/2013 None
9/4/2013 None
N/A
N/A
8/19/2013 None
N/A
10/22/2012 None
N/A
7/1/2011 None
N/A
PHOENIX
AZ
ACTIVE
9/17/2008 None
N/A
PHOENIX
AZ
ACTIVE
ACTIVE
10/29/2012 None
4/6/2011 None
N/A
N/A
RICHMOND
TX
ACTIVE
4/6/2011 None
N/A
DALLAS
CORPUS
CHRISTI
TX
ACTIVE
4/26/2010 None
N/A
TX
ACTIVE
6/13/2011 None
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
4/21/2011 None
10/31/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/6/2013 None
N/A
KALAMAZOO
MI
ACTIVE
ACTIVE
11/30/2011 None
1/13/2011 None
N/A
N/A
GENERAL SURGERY
FAMILY PRACTICE
PEDIATRIC
OPHTHALMOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
P5135
SIA, JOHN PATRICK AGUILAR, MD
12/17/2012
INTERNAL MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
P5135
12/17/2012
INTERNAL MEDICINE OMAHA
NE
P5135
12/17/2012
INTERNAL MEDICINE OMAHA
NE
N9130
SIBAL, AMAN, MD
SIDDIQI, MUHAMMAD NAVEED
SALEH, MD
License
Number
N6664
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
3/15/2011
6/4/2010
CARDIOVASCULAR
5/1/2017 DISEASES
PEDIATRIC
4/1/2018 NEPHROLOGY
PULMONARY
CRITICAL CARE
12/1/2016 MEDICINE
P3076
SIDDIQI, NAUMAN, MD
5/1/2012
P6084
SIDDIQUE, KHURRUM , MD
4/1/2013
P1594
SIDDIQUE, MUHAMMAD ASIM, MD
12/1/2011
P7035
P6723
SIDDIQUE, MUHAMMAD TALAL, MD
SIDDIQUE, QAZI ASIF, MD
6/14/2013
5/15/2013
P6273
N2299
SIDDIQUI, KIRAN F, MD
SIDDIQUI, REAZ MAHMOOD, MD
4/12/2013
2/6/2009
P6523
SIDDIQUI, UMAIR MAHMOOD, MD
5/1/2013
N5400
SIDHU, ANUPAM KAY, MD
2/5/2010
N8726
P2366
SIDHU, JASPREET SINGH, MD
SIDHU, NAVNEET, MD
2/4/2011
3/1/2012
P5136
SIDWANI-CHAWLA, SEEMA LAKHO,
DO
12/17/2012
P5136
DO
12/17/2012
P5136
DO
12/17/2012
Secondary Specialty
(Self-Designated)
Practice City
Disciplinary
Status Date
12/17/2012 None
N/A
ACTIVE
1/31/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/31/2013 None
N/A
3/15/2011 None
N/A
6/4/2010 None
N/A
INTERVENTIONAL
CARDIOLOGY
IRVING
TX
ACTIVE
5/4/2012 None
N/A
PEDIATRICS
DALLAS
TX
ACTIVE
4/5/2013 None
N/A
SLEEP MEDICINE
HOUSTON
TX
ACTIVE
12/20/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
7/10/2013 None
5/23/2013 None
N/A
N/A
4/12/2013 None
4/3/2009 None
N/A
N/A
5/1/2013 None
N/A
2/5/2010 None
N/A
LUBBOCK
CHILD AND
ADOLESCENT
PSYCHIATRY
HOUSTON
GASTROENTEROLOG
5/1/2018 Y
INTERNAL MEDICINE
OBSTETRICS AND
2/4/2016 GYNECOLOGY
ENDOCRINOLOGY,
DIABETES AND
ENDOCRINOLOGY,
DIABETES AND
ENDOCRINOLOGY,
DIABETES AND
Registration
Status Date
Disciplinary
Status of
Texas
License
HOSPITALIST
Page 253 of 300
ATHENS
TYLER
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
TX
ACTIVE
ACTIVE
2/15/2011 None
3/5/2012 None
N/A
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
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P4613
SIFUENTES-DOMINGUEZ, LUIS
FERNANDO, MD
E6917
N8243
SIGMAN, ROBERT KARL, MD
SIGWORTH, STEPHEN, MD
P6525
SIKKA, SEEMA, MD
5/1/2013
N6025
SILAT, NOOMAN YOUNUS, MD
4/9/2010
N8574
SILBERBERG, ALAN DOUGLAS, MD
N5401
SILLER, SUZEL F, MD
N5403
N4749
SILVA MUSALEM, MARIEL , MD
SILVA, PAUL M, MD
N7001
N6026
P5728
SILVER, BRAD JOSEPH, MD
SIM, MEESUN RACHEL, MD
SIMHAN, JAY, MD
N9487
N4103
P2529
P2367
SIMKO, STEPHEN JAMES III, MD
SIMMONS, JASON LEVON, MD
SIMON, CYRIL MAKIL, DO
SIMON, GEORGE RAJAN, MD
4/15/2011
8/21/2009
3/15/2012
3/1/2012
P1227
N4104
SIMON, PATRICK MICHAEL, MD
SIMONS, NATHAN TREVOR, MD
10/17/2011
8/21/2009
P7708
SIMS, AMY ELIZABETH, MD
10/1/2012
10/17/2011
12/1/2010
OBSTETRICS AND
PHYSICAL MED. &
1/18/2011
2/5/2010
2/5/2010
11/6/2009
2/5/2015 PEDIATRICS
EMERGENCY
7/1/2015 MEDICINE
3/1/2018 UROLOGY
PEDIATRIC
HEMATOLOGY/ONCOL
4/15/2016 OGY
3/1/2017 ONCOLOGY
ORTHOPEDIC
10/17/2016 SURGERY
PEDIATRICS,
7/1/2010
4/9/2010
3/1/2013
8/15/2013
N8244
SIMS, JAMES III, MD
12/1/2010
N6666
P7352
N9302
N4227
SINGAL, AMIT, MD
SINGEETHAM, SARITA D, MD
SINGH, AMRITA , MD
SINGH, HARAMANDEEP , MD
6/4/2010
7/15/2013
4/1/2011
11/6/2009
6/4/2015
7/15/2018
4/1/2016
11/6/2014
P1228
SINGH, HARBIR , MD
10/17/2011
Secondary Specialty
(Self-Designated)
Practice City
PEDIATRIC
GASTROENTEROLOG
Y
DALLAS
MATERNAL AND
FETAL MEDICINE
FORT WORTH
HOUSTON
SPINAL CORD
INJURY MEDICINE
CLEVELAND
ANESTHESIOLOGY
AUSTIN
Registration
Status of
Practice
Texas
State
License
ACTIVE
10/2/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
10/28/2011 None
12/8/2010 None
N/A
N/A
OH
ACTIVE
LICENSE
ISSUED
5/8/2013 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
1/24/2011 None
N/A
2/5/2010 None
N/A
2/5/2010 None
1/11/2010 None
N/A
N/A
7/5/2010 None
5/3/2010 None
3/11/2013 None
N/A
N/A
N/A
TX
DALLAS
TX
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
TX
TX
TX
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
4/15/2011
11/13/2009
3/22/2012
3/7/2012
None
None
None
None
N/A
N/A
N/A
N/A
SAN ANTONIO TX
BRENHAM
TX
ACTIVE
ACTIVE
10/24/2011 None
8/26/2009 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/16/2013 None
N/A
12/21/2010 None
N/A
DALLAS
HOUSTON
SAN RAMON
TX
TX
CA
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
6/4/2010
7/17/2013
4/7/2011
11/19/2009
None
None
None
None
N/A
N/A
N/A
N/A
DALLAS
TX
ACTIVE
10/24/2011 None
N/A
PEDIATRICS
HOUSTON
DALLAS
ODESSA
INFECTIOUS
DISEASES
GASTROENTEROLOG
Y
HEPATOLOGY
ANESTHESIOLOGY
PEDIATRICS
HOSPITALIST
SLEEP MEDICINE
PSYCHIATRY
EMERGENCY
10/17/2016 MEDICINE
Page 254 of 300
Disciplinary
Status Date
TX
OBSTETRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
N4753
SINGH, HITESH BHRIGUNATH, MD
P0296
SINGH, KRISHNA ANJALI, MD
N6028
SINGH, LAV, MD
N6669
P0498
N7492
dicaid
dicaid
Agreement
End Date
Designated)
11/6/2009
7/1/2011
ORTHOPEDIC
7/1/2016 SURGERY
4/9/2010
SINGH, LOTIKA , MD
SINGH, MANISH, MD
SINGH, SHANTNU, MD
6/4/2010
7/15/2011
8/16/2010
N7658
K7481
SINGH, SUPRIYA , MD
SINGH, SVETA, DO
9/1/2010
9/1/2011
N8245
N8246
SINGHAL, ARUN K, MD
SINGHAL, MONIKA DESAI, MD
12/1/2010
12/1/2010
THORACIC
CARDIOVASCULAR
12/1/2015 SURGERY
P7353
SINGLETON, TERRELL ANN, MD
7/15/2013
N4756
SINNOTT, BRIDGET P, MD
N1895
ONCOLOGY
INFECTIOUS
DISEASES
Practice City
TEMPLE
PARIS
TX
TX
MCALLEN
TX
INTERNAL MEDICINE TYLER
TX
PULMONARY
CRITICAL CARE
MEDICINE
SAN ANTONIO TX
LONGVIEW
LONGVIEW
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
12/11/2009 None
N/A
ACTIVE
7/11/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
4/15/2010 None
N/A
6/4/2010 None
8/16/2011 None
8/19/2010 None
N/A
N/A
N/A
ACTIVE
ACTIVE
9/14/2010 None
11/30/2011 None
N/A
N/A
ACTIVE
ACTIVE
12/13/2010 None
12/27/2010 None
N/A
N/A
ACTIVE
7/17/2013 None
N/A
11/6/2009
ENDOCRINOLOGY,
DIABETES AND
TX
ACTIVE
11/16/2009 None
N/A
12/12/2008
CLINICAL
NEUROPHYSIOLOGY DALLAS
TX
ACTIVE
12/17/2008 None
N/A
10/15/2012
DIAGNOSTIC
8/29/2013 RADIOLOGY
SUGARLAND
TX
ACTIVE
1/9/2013 None
N/A
CHAPEL HILL
NC
ACTIVE
LICENSE
ISSUED
10/7/2008 None
N/A
6/4/2010 None
N/A
1/12/2011 None
N/A
10/29/2010 None
1/9/2012 None
N/A
N/A
10/11/2011 None
N/A
P4716
SIRSI, DEEPA , MD
SISTA, SATHYADEVI
RAJYALAKSHMI, MD
N1150
SIVAK, NATALIE LEILA MANGE, MD
8/29/2008
N6671
6/4/2010
N8062
P1818
SIVAKUMAR, ANUPAMA, MD
SIVAPRAKASAPILLAI, BRAHMESH,
MD
SIVAPRAKASAPILLAI, NIRMALA
MAYA, MD
SIVASANKAR, CHITRA, MD
P1142
SKAPEK, STEPHEN XAVIER, MD
N8148
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
11/15/2010
10/29/2010
1/2/2012
10/3/2011
6/4/2015 PSYCHIATRY
GASTROENTEROLOG
10/29/2015 Y
PEDIATRIC
HEMATOLOGY/ONCOL
10/3/2016 OGY
Page 255 of 300
SAYRE
PA
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P3669
SKEENS, JOSEPH LESLIE, MD
6/15/2012
P6088
N8988
SKEFOS, CHRYSTAN MARIA, MD
SKELTON, HILLARY ALAINE, MD
4/1/2013
3/1/2011
N9133
SKIDMORE, KIMBERLY LYNN, MD
3/15/2011
P1698
N3313
SKINNER, HEATH DEVIN, MD
SKLAR, LISA CARRIE, DO
12/15/2011
5/29/2009
CE00003 SLADE, HERBERT BRYAN, MD
2/4/2011
TM00454 SLOVES, JAMES HOWARD, MD
7/1/2011
P5004
SMELTER, PAUL JOHN, MD
11/30/2012
N1151
SMITH, ALLISON LEIGH, MD
8/29/2008
N1896
P7709
12/12/2008
8/15/2013
P7710
SMITH, BENJAMIN DAVID, MD
SMITH, CAMERON , MD
SMITH, CODY WILLIAM DUNBAR,
MD
P1229
SMITH, DUSTIN RICKY, MD
10/17/2011
P1927
8/15/2013
N4113
SMITH, EBONI MIKELLE, MD
SMITH, ELIZABETH ANN ROCHE,
MD
N6030
SMITH, JEREMY RYAN, MD
N4115
N8989
SMITH, JORDAN MICHAEL, DO
SMITH, JOSHUA MICHAEL, MD
8/21/2009
3/1/2011
P5731
N2302
N4759
SMITH, JOY MONICA, MD
SMITH, JUSTIN RAY, MD
SMITH, KAREN DOROTHY , MD
3/1/2013
2/6/2009
11/6/2009
6/15/2017 RADIOLOGY
EMERGENCY
4/1/2018 MEDICINE
3/1/2016 PEDIATRICS
RADIATION
12/15/2016 ONCOLOGY
ALLERGY AND
2/4/2016 IMMUNOLOGY
DIAGNOSTIC
7/1/2016 RADIOLOGY
PEDIATRICS
OBSTETRICS AND
RADIATION
12/12/2013 ONCOLOGY
8/15/2018 RADIOLOGY
EMERGENCY
8/15/2018 MEDICINE
EMERGENCY
10/17/2016 MEDICINE
1/17/2012
8/21/2009
EMERGENCY
4/9/2015 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
3/1/2016 PEDIATRICS
OBSTETRICS AND
3/1/2018 GYNECOLOGY
2/6/2014 PEDIATRICS
4/9/2010
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
RADIOLOGY
PEDIATRICS
Page 256 of 300
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/15/2012 None
N/A
KATY
TX
ACTIVE
ACTIVE
4/17/2013 None
3/23/2011 None
N/A
N/A
PALMDALE
CA
ACTIVE
4/4/2011 None
N/A
HOUSTON
TEMPLE
TX
TX
ACTIVE
ACTIVE
12/22/2011 None
6/24/2009 None
N/A
N/A
FORT WORTH TX
ACTIVE
2/14/2011 None
N/A
EDEN PRAIRIE MN
ACTIVE
SPRINGFIELD IL
ACTIVE
DALLAS
LACKLAND
AFB
TEMPLE
TX
ACTIVE
TX
TX
8/11/2011 None
SEE
PREVIOUS
12/10/2012 ORDER
N/A
12/3/2012
9/16/2008 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
12/29/2008 None
8/19/2013 None
N/A
N/A
8/15/2013 None
N/A
DALLAS
TX
ACTIVE
11/16/2011 None
N/A
HOUSTON
TX
ACTIVE
1/26/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
9/7/2009 None
N/A
4/9/2010 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
8/26/2009 None
3/4/2011 None
N/A
N/A
DALLAS
ABILENE
EL PASO
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
3/20/2013 None
2/10/2009 None
11/16/2009 None
N/A
N/A
N/A
License
Number
Physician Name
N6031
SMITH, KIRK LANE, MD
P2532
SMITH, LAUREN QUIRK, MD
P3244
P7571
P6526
SMITH, MELODY , MD
SMITH, NATALIE MARIE, MD
SMITH, PAUL JOSEPH, MD
P4718
SMITH, ROBERT STEPHEN, MD
dicaid
dicaid
Agreement
End Date
Designated)
GENERAL
PREVENTIVE
4/9/2010
4/9/2015 MEDICINE
OBSTETRICS AND
3/15/2012
5/15/2012
8/1/2013
5/1/2013
10/15/2012
N8729
SMITH, RONALD DOUGLAS JR, MD
2/4/2011
N2815
SMITH, SHARON ALTHEA , MD
4/3/2009
N5409
SMITH, STACEY LANELL, MD
2/5/2010
N4116
N1456
P4615
P7572
SMITH, SUMONA VERSIE , MD
SMITH, TAWANA LAKESHA, MD
SMITH, TODD BENEDICT, MD
SMITH, WILLIAM ALFRED JR, MD
N2818
SMITH-SHAM, STEPHANIE DEE, MD
P0139
SMOCK, DAVID MCCLAIN, MD
6/15/2011
P3454
N8149
SMYTH, MICHAEL HENRY, MD
SNELL, TRACY , DO
6/1/2012
11/15/2010
P1410
N8576
SNIEGOWSKI, MATTHEW
CONRAD, MD
SNYDER, PHILIP CRAIG, MD
N8855
P0500
SOANS, FRANCIS PETER, MD
SOBAMOWO, HEZEKIAH
OLUWAROTIMI, MD
SOBANDE, PATRICK OLAMIDOTUN,
MD
P2066
SOBREVILLA, JOSE RICARDO, MD
P1595
8/21/2009
10/10/2008
10/1/2012
8/1/2013
4/3/2009
11/4/2011
1/18/2011
2/15/2011
12/1/2011
7/15/2011
2/1/2012
ANATOMIC/CLINICAL
OBSTETRICS AND
4/3/2014 GYNECOLOGY
ANATOMIC/CLINICAL
2/5/2015 PATHOLOGY
Secondary Specialty
(Self-Designated)
ACTIVE
4/14/2010 None
N/A
TEMPLE
TX
3/20/2012 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
5/15/2012 None
8/5/2013 None
5/6/2013 None
N/A
N/A
N/A
ALPHARETTA
GA
ACTIVE
LICENSE
ISSUED
10/19/2012 None
N/A
2/4/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/10/2009 None
N/A
2/5/2010 None
N/A
HOUSTON
TX
DALLAS
TEXAS CITY
AUSTIN
IRVING
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
INTERNAL MEDICINE
OBSTETRICS AND
GYNECOLOGY
DALLAS
TX
TX
PEDIATRIC
HOSPITALIST
Page 257 of 300
Disciplinary
Status Date
TX
CARDIOVASCULAR
SURGERY
VASCULAR SURGERY GENERAL SURGERY
FAMILY MEDICINE
ORTHOPEDICS
UROLOGIC SURGERY
OBSTETRICS AND
4/3/2014 GYNECOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
GALVESTON
HEMATOLOGY/ONCO
LOGY
8/21/2014
10/10/2013
10/1/2017
8/1/2018
Practice City
Registration
Status of
Practice
Texas
State
License
NEW
ORLEANS
MCALLEN
LA
TX
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
5/11/2009 None
N/A
6/15/2011 None
N/A
6/1/2012 None
1/12/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
11/15/2011 None
1/24/2011 None
N/A
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
2/6/2012 None
N/A
7/15/2011 None
N/A
2/6/2012 None
N/A
ACTIVE
9/14/2009
1/2/2009
10/15/2012
8/27/2013
License
Number
Physician Name
N1154
SOE, THET , MD
J5485
SOFINSKI, SANDRA JEAN, MD
N8856
SOKAL, JOSEPH O, MD
N6675
SOKKARY, NANCY A, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/29/2008
3/1/2012
2/15/2011
6/4/2010
OPHTHALMOLOGY ANTERIOR SURGERY MONTCLAIR
CA
OBSTETRICS AND
6/4/2015 GYNECOLOGY
6/4/2010
6/4/2015 RADIOLOGY
3/1/2012
N5411
SOLANO, ILIANA , MD
2/5/2010
P7210
7/1/2013
N4120
SOLANO, ROY, MD
SOLIPURAM, ARUN KUMAR REDDY
, MD
2/5/2015 PEDIATRICS
EMERGENCY
7/1/2018 MEDICINE
8/21/2009
P3587
N7879
N4764
SOLOMON, MATTHIAS, MD
SOLOMON, SABRINA ANN, MD
SOLTERO REYES, LILIANA , MD
6/8/2012
10/1/2010
11/6/2009
P1231
SOMA, VIKAS REDDY, MD
P3078
5/1/2012
N1156
SOMAIAH, NEETA, MD
SOMASUNDARAVELAYUDHAM,
SUDHA THANGAM, MD
CARDIOVASCULAR
10/17/2016 DISEASES
HEMATOLOGY/ONCOL
5/1/2017 OGY
8/29/2008
P1023
SOMAYAZULA, RAVI KIRAN, DO
9/15/2011
P1411
SOMMERS, ROSS, MD
11/4/2011
P2370
N9136
N1157
SON, COLIN TOWNES, MD
SONI, RUHI SINGH, MD
SOOD, VINEETA , MD
3/1/2012
3/15/2011
8/29/2008
N9304
SOPONTAMMARAK, SOMKIAT, MD
4/1/2011
Practice City
TM00372 SOKOL, JOSHUA ROBERT, MD
SOKUNBI, ABIMBOLA OLAYINKA,
P2369
MD
10/17/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
CANC NONPAYMENT
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/2/2009 None
N/A
3/7/2012 None
N/A
2/15/2011 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
3/6/2012 None
N/A
2/5/2010 None
N/A
DALLAS
GERIATRICS INTERNAL MEDICINE SALEM
TX
ACTIVE
7/25/2013 None
N/A
OR
ACTIVE
9/21/2009 None
N/A
GENERAL SURGERY DULUTH
SAN ANTONIO
NEPHROLOGY
HOUSTO
INTERVENTIONAL
CARDIOLOGY
URBANAI
MN
TX
TX
ACTIVE
ACTIVE
ACTIVE
6/20/2012 None
10/11/2010 None
12/21/2009 None
N/A
N/A
N/A
IL
ACTIVE
11/16/2011 None
N/A
INTERNAL MEDICINE CHARLESTON SC
ACTIVE
5/10/2012 None
N/A
HOSPITALIST
ACTIVE
9/18/2008 None
N/A
GENERAL SURGERY SUGARLAND
ACTIVE
9/22/2011 None
N/A
LICENSE
ISSUED
11/4/2011 None
N/A
NEUROLOGICAL
3/1/2017 SURGERY
INTERNAL MEDICINE
PEDIATRICS,
4/1/2016 CARDIOLOGY
Page 258 of 300
SAN ANTONIO TX
TX
SAN ANTONIO TX
HOUSTON
TX
LUBBOCK
TX
ACTIVE
ACTIVE
ACTIVE
3/20/2012 None
3/28/2011 None
10/10/2008 None
N/A
N/A
N/A
LUBBOCK
ACTIVE
4/6/2011 None
N/A
TX
License
Number
Physician Name
P2927
SORAJJA, DAN, MD
P2790
SORENSEN, BRIAN SHAW, MD
K6339
SORIA, DAVID MICHAEL, MD
SOROLLA-OLYMPIA, MARICELLE
GOINGCO, MD
N8064
P3079
P0675
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CARDIAC
ELECTROPHYSIOLOG
4/13/2012
4/13/2017 Y
CARDIOLOGY
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
EMERGENCY
8/26/2011
8/26/2016 MEDICINE
10/29/2010
N7493
N7970
P3670
SORRENTINO, DAVID ALAN, DO
SOSA PEREZ, SUALY , MD
SOSA RODRIGUEZ, JAVIER
EDUARDO, MD
SOSA, ISMAEL TRES, MD
SOSA, JACQUELINE QUINN, MD
8/16/2010
10/15/2010
6/15/2012
P7355
SOTO, ELEAZAR EDUARDO, MD
7/15/2013
N6036
SOUDER, NICHOLAS PAUL, MD
4/9/2010
P6922
N1161
P5305
P2372
SOUSA, TATIANA SILVA, MD
SOWELL, ELIZABETH SANDOVAL,
MD
SPAGNUOLO, MICHAEL WILLIAM,
DO
SPANN, BRYAN MICHAEL-PAUL,
DO
5/1/2012
8/1/2011
6/3/2013
8/29/2008
1/15/2013
3/1/2012
P1597
P6527
SPARKS, CHARISSE YVETTE, MD
SPATH, FUAD ANTONIO, MD
P6092
SPEARS, BRIAN THOMAS, MD
4/1/2013
P3588
SPEARS, GREGORY LYNN, MD
6/8/2012
P5006
N9648
P2534
SPEARS, MICHAEL DON, MD
SPECK, MICHAEL CHRISTOPHER,
MD
SPENCE, TIMOTHY AARON, MD
12/1/2011
5/1/2013
11/30/2012
5/2/2011
3/15/2012
EMERGENCY
5/1/2017 MEDICINE
OBSTETRICS AND
ORTHOPEDIC
4/9/2015 SURGERY
3/1/2017 NEUROLOGY
ORTHOPEDIC
12/1/2016 TRAUMA
EMERGENCY
4/1/2018 MEDICINE
EMERGENCY
6/8/2017 MEDICINE
LICENSE
ISSUED
PEDIATRICS
MATERNAL AND
FETAL MEDICINE
N/A
4/3/2012 None
N/A
DENISON
TX
ACTIVE
LICENSE
ISSUED
9/6/2011 None
N/A
10/29/2010 None
N/A
5/3/2012 None
9/6/2011 None
N/A
N/A
8/16/2010 None
10/22/2010 None
6/19/2012 None
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
8/15/2013 None
N/A
TEMPLE
TX
ACTIVE
4/27/2010 None
N/A
SUGAR LAND
TX
ACTIVE
6/4/2013 None
N/A
HOUSTON
TX
ACTIVE
10/16/2008 None
N/A
ACTIVE
1/17/2013 None
N/A
TX
ACTIVE
3/5/2012 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
12/6/2011 None
7/2/2013 None
N/A
N/A
4/8/2013 None
N/A
6/8/2012 None
N/A
ACTIVE
LICENSE
ISSUED
Page 259 of 300
4/13/2012 None
ACTIVE
HOUSTON
Disciplinary
Status Date
TX
ORTHOPEDIC
SURGERY
HEMATOLOGY
(PATHOLOGY)
Registration
Status Date
Disciplinary
Status of
Texas
License
ABILENE
TYLER
HOUSTON
DERMATOLOGIC
SURGERY
EMERGENCY
8/29/2013 MEDICINE
ORTHOPEDIC
1/15/2018 SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
MINNEAPOLIS MN
ACTIVE
12/4/2012 None
N/A
TACOMA
ACTIVE
ACTIVE
5/10/2011 None
3/27/2012 None
N/A
N/A
WA
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N9305
SPENGLER, ADAM LAUBACH, MD
4/1/2011
N6676
SPINELLI, JAMES P JR, DO
6/4/2010
N6677
SPRINGSTON, CHRISTA RENE, MD
6/4/2010
P0796
SPRINTZ, MICHAEL PHILLIP, DO
N1460
P2535
P1494
SPROCKEL, PETER TIMOTHY, MD
SQUYRES, JUSTIN DAYLE, MD
SRESHTA, ERIN GEORDI, MD
10/10/2008
3/15/2012
11/15/2011
P5733
P1232
P4616
P7857
SRESHTA, JOSEPH NICHOLAS, MD
SRIDHAR, SRIKANTH , MD
SRINIVAS, GOWRI SHASHI, MD
SRINIVASAN, ASHMITHA, MD
3/1/2013
10/17/2011
10/1/2012
8/30/2013
N9779
SRIVASTAVA, NALIN KUMAR, MD
N8065
N7587
ST CYR, CALEB JOSEPH, DO
ST VICTOR, RUTH, DO
P2537
P7211
STAFFORD, AMY , MD
STAFFORD, REBECCA ELIZABETH,
MD
STAGGS, BRENT CHRISTOPHER,
MD
N9306
STAHL, DANIEL LEE, MD
N8350
N6679
STALL, ALEC CHRISTIAN, MD
STALLWORTH, CHRISTIAN LANE,
MD
N8731
P5479
STAMATAKIS, LAMBROS , MD
STAN, ANA DESPINA, MD
2/4/2011
2/1/2013
2/1/2018 PSYCHIATRY
N8462
STANCIU, NATALIE, MD
1/3/2011
P1025
8/15/2011
PHYSICAL MED. &
6/4/2010 None
N/A
6/4/2010 None
N/A
LUBBOCK
TX
FORT WORTH TX
GALVESTON TX
ACTIVE
ACTIVE
ACTIVE
10/21/2008 None
3/19/2012 None
11/22/2011 None
N/A
N/A
N/A
3/1/2018
10/17/2016
10/1/2017
8/30/2018
GALVESTON
HOUSTON
DALLAS
HOUSTON
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/6/2013
10/24/2011
10/5/2012
9/4/2013
None
None
None
None
N/A
N/A
N/A
N/A
5/16/2011 None
N/A
10/29/2010 None
9/6/2010 None
N/A
N/A
3/15/2012 None
N/A
10/24/2011 None
N/A
6/4/2010
N/A
N/A
9/15/2011
12/15/2010
4/6/2011 None
8/22/2011 None
7/1/2018 PATHOLOGY
ORTHOPEDIC
4/1/2016 SURGERY
PEDIATRIC
FACIAL PLASTIC
6/4/2015 SURGERY
BREAST IMAGING
HOUSTON
Disciplinary
Status Date
ACTIVE
ANESTHESIOLOGY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
3/15/2012
4/1/2011
TX
PAIN MEDICINE
10/29/2010
8/27/2010
7/1/2013
Practice City
HOUSTON
UROLOGY
ANESTHESIOLOGY
PEDIATRICS
RADIOLOGY
CARDIOVASCULAR
5/16/2016 DISEASES
EMERGENCY
10/29/2015 MEDICINE
5/16/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
TX
OBSTETRICS
HOSPITALIST
HEMATOLOGY
(PATHOLOGY)
ORTHOPEDIC
TRAUMA
EL PASO
TX
ACTIVE
LITTLE ROCK
AR
ACTIVE
LICENSE
ISSUED
7/3/2013 None
N/A
4/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
12/28/2010 None
N/A
6/4/2010 None
N/A
2/4/2011 None
2/5/2013 None
N/A
N/A
1/3/2011 None
N/A
DALLAS
TX
OTOLARYNGOLOGY
DALLAS
OPHTHALMOLOGY RECONST SURGERY
Page 260 of 300
TX
LICENSE
ISSUED
dicaid
dicaid
License
Agreement
Physician Name
Start Date
End Date
Designated)
EMERGENCY
P5892
STANDIFER, JESSE ARTHUR II, MD
3/15/2013
3/15/2018 MEDICINE
STANLEY, GREGORY ALAN, MD
STANLEY, JAY MICHAEL, MD
6/4/2010
4/9/2010
L6654
8/1/2011
N6681
N8151
P5736
STARK, JAMES MATTHEW, MD
STARLING, CHERRY ELIZABETH,
MD
STARNES, CODY , MD
STAUB, LAURA LEY, MD
N6682
STAVINOHA, ROSE CAITLIN, MD
6/4/2010
6/4/2015 PATHOLOGY
PEDIATRIC
P3672
6/15/2012
N6683
STEANS, MARIA CECILIA, MD
STEARNS, CHRISTOPHER ALAN,
MD
6/4/2010
N8577
P1932
P7713
N6041
STEEL, RICHARD JOSEPH, MD
STEFFER, KAREN JUNE, MD
STEFFY, DANIEL ANTHONY, MD
STEIER, JAMES MAURICE, MD
1/18/2011
1/17/2012
8/15/2013
4/9/2010
N7751
9/15/2010
N7752
STEINMAN, HOWARD , MD
STEINMETZ, STEFFANY BROOKE,
DO
N6686
STEINOUR, NICHOLAS PAUL, MD
6/4/2010
P1414
STELL, CASEY NICOLE, DO
L3143
STEPHENS, CHAD BRYAN, DO
STEPHENS, NATHANIEL
BRANDON, DO
2/5/2010
STEPHENSON, SHARISSE, MD
STERENCHOCK, TRENT DOUGLAS,
MD
6/4/2010
6/4/2015 NEUROLOGY
6/1/2012
6/1/2017 UROLOGY
P0301
N6687
P3456
9/15/2010
11/4/2011
7/1/2011
INTERNAL MEDICINE
INTERNAL MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
MOHS
MICROGRAPHIC
9/15/2015 SURGERY
Practice City
ORLANDO
VASCULAR
6/4/2015 ABDOMINAL SURGERY SURGERY
PEDIATRIC
PEDIATRICS
N6680
N6040
6/4/2010
11/15/2010
3/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
FL
SAN ANTONIO TX
HOUSTON
TX
HOUSTON
HOUSTON
TX
TX
CYTOPATHOLOGY
PALLIATIVE
MEDICINE
1/18/2016
1/17/2017
8/15/2018
4/9/2015
DERMATOLOGIC
SURGERY
EMERGENCY
6/4/2015 MEDICINE
EL PASO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
3/19/2013 None
N/A
6/4/2010 None
4/26/2010 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
8/5/2011 None
N/A
6/4/2010 None
11/18/2010 None
3/5/2013 None
N/A
N/A
N/A
6/4/2010 None
N/A
6/19/2012 None
N/A
6/4/2010 None
N/A
None
None
None
None
N/A
N/A
N/A
N/A
DALLAS
AUSTIN
OMAHA
TX
TX
NE
TEMPLE
TX
ACTIVE
9/22/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
9/21/2010 None
N/A
6/4/2010 None
N/A
11/4/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
7/6/2011 None
N/A
6/4/2010 None
N/A
ACTIVE
6/5/2012 None
N/A
BURNET
BEAUMONT
Page 261 of 300
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
DUNCANVILLE TX
PAIN
MANAGEMENT/REHAB SPORTS MEDICINE
2/5/2015 MED
(FAMILY PRACTICE)
EMERGENCY
7/1/2016 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
1/18/2011
1/25/2012
8/21/2013
4/26/2010
License
Number
Physician Name
N4128
STERN, AUGUSTUS GRAHAM, MD
N6688
STERN, ERIC WILLIAM, MD
N7352
P7576
STERN, HERBERT JOEL, MD
STEVENER, DAVID SCOTT, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/21/2009
6/4/2010
8/2/2010
8/1/2013
N9965
STEVENS, ALEXANDRA MCLEAN,
MD
STEVENS, CHRISTOPHER
BARNETT, MD
P2374
N8352
STEVENSON, MATTHEW
TERRENCE, MD
STEWART, ADAM KEITH, MD
P7356
P3248
STEWART, JESSICA DANIELLE, MD
STEWART, JULIE NICOLE, MD
7/15/2013
5/15/2012
N8858
STIKE, AARON BRONDELL, MD
2/15/2011
N7004
STILES, WILLIAM FREMONT III, DO
7/1/2010
N6043
STILLINGS, JOEL DAVID, DO
4/9/2010
N6689
STITH, WILLIAM JOSEPH JR, DO
6/4/2010
P6727
5/15/2013
6/3/2011
3/1/2012
12/15/2010
E6635
P6282
STOCKMAN, GAIL DIANE, MD
STONE, JAMILLA CHRISTINE, MD
11/15/2012
4/12/2013
P4515
STONE, KENNETH ERIC, MD
P5572
STOUFFER, MARK HAROLD, MD
P4618
STOWELL, JEFFREY RANDAL, MD
10/1/2012
N7179
STRAHAN, ARTHUR LANE JR, MD
7/15/2010
9/17/2012
2/8/2013
EMERGENCY
6/4/2015 MEDICINE
Secondary Specialty
(Self-Designated)
CORNEA
REFRACTIVE
SURGERY
PEDIATRICS,
CARDIOLOGY
8/2/2015 PEDIATRICS
PEDIATRIC
HEMATOLOGY/ONCOL
5/15/2018 OGY
PEDIATRICS
OBSTETRICS AND
6/3/2016 GYNECOLOGY
NEURO-PHYSIOLOGY
3/1/2017 NEUROLOGY
(NEUROLOGY)
EMERGENCY
7/15/2018 MEDICINE
Practice City
HUMBLE
Registration
Status of
Practice
Texas
State
License
TX
ORTHOPEDIC
SURGERY OF THE
2/8/2018 SPINE
EMERGENCY
10/1/2017 MEDICINE
ORTHOPEDIC
7/15/2015 SURGERY
ACTIVE
LICENSE
ISSUED
9/2/2009 None
N/A
6/4/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
8/5/2010 None
8/2/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
6/4/2013 None
N/A
FORT WORTH TX
ACTIVE
6/13/2011 None
N/A
FORT WORTH TX
TEMPLE
TX
ACTIVE
ACTIVE
3/12/2012 None
12/21/2010 None
N/A
N/A
PASADENA
HOUSTON
ACTIVE
ACTIVE
LICENSE
ISSUED
7/16/2013 None
6/18/2012 None
N/A
N/A
2/15/2011 None
N/A
TX
TX
TYLER
TX
ACTIVE
7/15/2010 None
N/A
KILLEEN
TX
ACTIVE
LICENSE
ISSUED
4/26/2010 None
N/A
6/4/2010 None
N/A
PULMONARY
MEDICINE
CORSICANA
LULING
FORT SAM
TX
TX
ACTIVE
ACTIVE
11/20/2012 None
4/22/2013 None
N/A
N/A
TX
ACTIVE
9/24/2012 None
N/A
2/8/2013 None
N/A
LICENSE
ISSUED
Page 262 of 300
Disciplinary
Status Date
CORPUS
CHRISTI
CORSICANA
2/15/2016 UROLOGY
EMERGENCY
4/9/2015 MEDICINE
EMERGENCY
6/4/2015 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
ACTIVE
10/3/2012 None
N/A
MARSHALL
TX
ACTIVE
7/20/2010 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
8/27/2010
PEDIATRICS
N7588
STRAIGHT, ANN MARIE, MD
N4766
N3331
N3332
STRATTON, MICHAEL OGDEN, DO
STRAUSS, BRIAN LOUIS, MD
STREAM, AMANDA RAE, MD
P5738
STREET, MEGAN HICKMAN, MD
N3333
STREET, REAGAN MICHELLE, MD
P3081
STRICKLAND, KIMBERLY LYNN, DO
5/1/2012
P6924
STRODER, RYAN ANDREW, DO
6/3/2013
P5739
STRYKER, LOUIS SAMUEL, MD
3/1/2013
N8463
STUART, GILLIAN JOSEPHINE, MD
1/3/2011
N1164
STUART, STEPHANIE , MD
P5180
STUBBS, JENEE' GIBSON, MD
P3673
N4137
STUBBS, WILL III, DO
STUDENY, SIMON , MD
11/6/2009
5/29/2009
5/29/2009
3/1/2013
5/29/2009
8/29/2008
1/4/2013
6/15/2012
8/21/2009
5/29/2014 PATHOLOGY
PEDIATRIC
EMERGENCY
OBSTETRICS AND
4/1/2011
8/21/2009
N9310
P6531
SUAREZ, GUILLERMO MANUEL, MD
SUBNANI, KISHORE RAJ, MD
4/1/2011
5/1/2013
P6094
SUBRAMANIAM, HAMSA, MD
SUBRAMANIAM, SUBHASHINI
CIRUMANUR, MD
SUBRAMANIAN,
OBULAKSHMIPRIYA, MD
SUBRAMANIAN, VAIRAVAN
SARAVANAN JR, MD
4/1/2013
FAMILY MEDICINE
2/5/2010
INTERNAL MEDICINE
4/3/2009
2/5/2015 NEPHROLOGY
INFECTIOUS
4/3/2014 DISEASES
3/1/2011
3/1/2016 UROLOGY
N2436
N8994
N/A
N/A
N/A
LICENSE
ISSUED
3/1/2013 None
N/A
ACTIVE
6/9/2009 None
N/A
ACTIVE
5/10/2012 None
N/A
FORT WORTH TX
ACTIVE
6/5/2013 None
N/A
CHARLOTTE
ACTIVE
LICENSE
ISSUED
3/11/2013 None
N/A
1/3/2011 None
N/A
ACTIVE
9/8/2008 None
N/A
ACTIVE
1/11/2013 None
N/A
ACTIVE
ACTIVE
6/20/2012 None
8/27/2009 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
4/11/2011 None
8/31/2009 None
N/A
N/A
4/1/2011 None
5/15/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/8/2013 None
N/A
2/5/2010 None
N/A
TX
ACTIVE
5/8/2009 None
N/A
FORT WORTH TX
ACTIVE
3/9/2011 None
N/A
TX
NC
TX
PSYCHIATRY
STURM-O'BRIEN, ANGELA KAY, MD
SU, MU , MD
N5420
8/21/2014 PATHOLOGY
EMERGENCY
4/1/2016 MEDICINE
11/12/2009 None
6/29/2009 None
6/12/2009 None
TEMPLE
N9309
N4138
DALLAS
TX
HOUSTON
DALLAS
TX
TX
REDWOOD
VALLEY
DALLAS
Page 263 of 300
Disciplinary
Status Date
N/A
GALVESTON
FACIAL PLASTIC
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
8/27/2010 None
GENERAL PRACTICE SAN ANTONIO TX
LAS VEGAS
NV
EMERGENCY
6/3/2018 MEDICINE
ORTHOPEDIC
3/1/2018 SURGERY
EMERGENCY
8/29/2013 MEDICINE
PEDIATRIC
1/4/2018 PSYCHIATRY
EMERGENCY
6/15/2017 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
CA
ACTIVE
ACTIVE
ACTIVE
License
Number
P3249
N7753
Physician Name
SUFFIELD, JILL J, MD
SUGUMARAN, RAMASAMY T, MD
dicaid
dicaid
Agreement
End Date
Designated)
5/15/2012
9/15/2010
11/6/2009
N8732
2/4/2011
P2376
P0302
SUHR, EUNICE , MD
SULEIMAN, EHAB SAID ABDEL
AZIZ, MD
SULEIMAN, YOUSEF NABIL, MD
N6695
SULLIVAN, CLYDE II, MD
6/4/2010
N6696
K6350
SULLIVAN, JULIE MARIE, MD
SUMMERS, JOHN HOWARD, MD
6/4/2010
12/15/2011
N8996
N7972
SUMMERS, SHANE MICHAEL, MD
SUN, DONGXU , MD
3/1/2011
10/15/2010
P0677
SUN, JACHI GEORGE, MD
N1464
P0678
SUNDARAM, SUBHA , MD
SUNDERAJAN, KIRTANA , MD
N9311
4/1/2011
4/1/2016 PEDIATRICS
N9650
SUNDERLAND, KELLY M, MD
SUNDERMEYER, RICHARD LEVI III,
MD
5/2/2011
P3458
SUNG, ANGIE C, MD
6/1/2012
P6731
SUNKERSETT, GAURI
BHUPENDRA, DO
P2792
N5422
N6700
SUNNAPWAR, ABHIJIT , MD
SUPSUPIN, EMILIO PATACSIL JR,
MD
SUREKA, ASHISH OMPRAKASH,
MD
10/10/2008
8/1/2011
5/15/2013
4/2/2012
HUBER
HEIGHTS
SUHR, ABRAHAM WONDUK, MD
8/1/2011
Practice City
N4770
3/1/2012
7/1/2011
Secondary Specialty
(Self-Designated)
EMERGENCY
2/4/2016 MEDICINE
6/4/2015 CARDIOLOGY
EMERGENCY
6/4/2015 MEDICINE
EMERGENCY
3/1/2016 MEDICINE
10/15/2015
GASTROENTEROLOG
8/1/2016 Y
OBSTETRICS AND
OH
SAN ANTONIO TX
TEMPLE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
VASCULAR MEDICINE MCALESTER
WACO
TX
OK
TX
VASCULAR MEDICINE
MUSKOGEE
OK
6/4/2010
6/4/2015 PEDIATRICS
5/15/2012 None
N/A
9/20/2010 None
N/A
ACTIVE
LICENSE
ISSUED
11/11/2009 None
N/A
2/4/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
3/12/2012 None
7/11/2011 None
N/A
N/A
6/4/2010 None
N/A
6/4/2010 None
1/4/2012 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
3/11/2011 None
10/20/2010 None
N/A
N/A
OBSTETRICS AND
GYNECOLOGY
DALLAS
TX
OKLAHOMA
CITY
OK
ACTIVE
8/22/2011 None
N/A
ACTIVE
ACTIVE
10/20/2008 None
8/22/2011 None
N/A
N/A
ACTIVE
4/14/2011 None
N/A
ACTIVE
LICENSE
ISSUED
5/16/2011 None
N/A
6/1/2012 None
N/A
ACTIVE
5/16/2013 None
N/A
4/4/2012 None
N/A
2/5/2010 None
N/A
6/4/2010 None
N/A
PEDIATRIC
HEMATOLOGY/ONCOL
5/15/2018 OGY
ABDOMINAL
4/2/2017 RADIOLOGY
2/5/2015 NEURORADIOLOGY
Disciplinary
Status Date
SAN ANTONIO TX
DALLAS
TX
FORT WORTH TX
2/5/2010
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
SAN ANTONIO TX
RADIOLOGY
Page 264 of 300
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
P3250
N4772
Physician Name
SURI, MUHAMMAD FAREED KHAN,
MD
P0142
SUSSMAN, ZACHARY MICHAEL, MD
SUTCLIFFE, DAVID LAWRENCE,
MD
P3459
SUTHERLUN, LYDIA ANN, MD
P0143
SUTTON, SHELBY ELIZABETH, MD
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
5/15/2012
5/15/2017 NEUROLOGY
11/6/2009
11/6/2014 PATHOLOGY
ROSWELL
NM
ACTIVE
6/15/2011
DALLAS
TX
ACTIVE
LICENSE
ISSUED
6/1/2012
6/15/2011
CARDIOVASCULAR
10/1/2015 SURGERY
N7883
SWAIN, TIMOTHY WHITZEL III, MD
10/1/2010
P4719
SWALDEK, GNIEWOMIRA, MD
N9313
SWANSON, ELI, MD
N7497
SWANSON, OLGA FLOMIN, MD
P0305
SWANSON, TODD A, MD
N6702
N4773
SWANSON, TODD VICTOR, MD
SWARR, PETER JAMES, MD
N5423
SWART, JENNIFER ESTELLE, MD
2/5/2010
P1145
SWORDS, RONAN THOMAS, MD
10/3/2011
ORTHOPEDIC
4/1/2016 TRAUMA
OBSTETRICS AND
RADIATION
7/1/2016 ONCOLOGY
ORTHOPEDIC
6/4/2015 SURGERY
DIAGNOSTIC
2/5/2015 RADIOLOGY
HEMATOLOGY/ONCOL
10/3/2016 OGY
P5740
SYAMALA, SHIRMILA, MD
3/1/2013
10/15/2012
4/1/2011
8/16/2010
7/1/2011
6/4/2010
11/6/2009
N8581
SYED, ASIF SULTAN, MD
1/18/2011
P3254
P4517
SYED, WAQAR, MD
SYED, ZUBAIR AHMED, MD
5/15/2012
9/17/2012
N8733
SYEDA, SARA JABEEN, MD
2/4/2011
P2540
SYEDA, UZMA AHMAD, MD
3/15/2012
N/A
11/18/2009 None
N/A
6/20/2011 None
N/A
6/1/2012 None
N/A
LICENSE
ISSUED
6/15/2011 None
N/A
TX
ACTIVE
10/5/2010 None
N/A
PHILADELPHIA PA
ACTIVE
11/5/2012 None
N/A
HOUSTON
CA
ACTIVE
4/11/2011 None
N/A
GALVESTON
TX
ACTIVE
9/3/2010 None
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
7/8/2011 None
N/A
6/4/2010 None
11/19/2009 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
10/4/2011 None
N/A
3/1/2013 None
N/A
GA
ACTIVE
2/14/2011 None
N/A
MS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/4/2012 None
10/4/2012 None
N/A
N/A
2/4/2011 None
N/A
3/15/2012 None
N/A
CORPUS
CHRISTI
PEDIATRICS
BRENTWOOD TN
MUSCULOSKELETAL
RADIOLOGY
SAN ANTONIO TX
GERIATRICS INTERNAL MEDICINE ATLANTA
EMERGENCY
MEDICINE
RULEVILLE
DALLAS
LAWTON
INTERNAL MEDICINE
Page 265 of 300
Disciplinary
Status Date
5/15/2012 None
HOSPITALIST
PULMONARY
CRITICAL CARE
MEDICINE
ORTHOPEDICS
Registration
Status Date
Disciplinary
Status of
Texas
License
OK
License
Number
Physician Name
N4144
P5482
SZEMA, ROBERT S, MD
SZERLIP, HAROLD MICHAEL, MD
P4911
SZERLIP, MOLLY, MD
N5424
SZYLLER, ALAIN HERBERT, MD
N1467
P6732
N7008
N8464
TA, NAHN , MD
TABE, JULIUS, MD
TACCIR-MACIAS, CLAUDIA
ADRIANA, MD
TADROS, EIRINY , MD
N5425
TADROS, YOUSEF EBEID , MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
8/21/2009
8/21/2014 MEDICINE
2/1/2013
INTERVENTIONAL
11/15/2012
CARDIOLOGY
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
2/5/2010
2/5/2015 GYNECOLOGY
SURGERY
10/10/2008
5/15/2013
7/1/2015 PSYCHIATRY
2/5/2010
N5426
TAGGART, GREGORY ALAN, MD
2/5/2010
N4774
P1236
P2378
TAIWO, JOSEPH BABAFEMI, MD
TAKKALLAPALLI, SRINU, MD
TAMEEZ, IFFAT, MD
11/6/2009
10/17/2011
3/1/2012
2/5/2015 PATHOLOGY
ORTHOPEDIC
2/5/2015 SURGERY
EMERGENCY
11/6/2014 MEDICINE
N6058
TAMEZ, ANGEL JOSE, MD
4/9/2010
P6925
N8066
P3255
TAN, ALVIN RAYMOND CO, MD
TAN, CRISTIANE CAMPOS, MD
TAN, JENS, MD
6/3/2013
10/29/2010
5/15/2012
4/9/2010
11/6/2009
10/15/2010
OBSTETRICS AND
4/9/2015 GYNECOLOGY
TAN, ORKUN, MD
TAN, YUE-QING , MD
TANEJA, AANCHAL , MD
P3461
TANG, ZHOUWEN , MD
6/1/2012
P6532
TANIGUCHI, CULLEN MITSUO, MD
5/1/2013
N8466
N2832
TANIMU, SABO BUKAR, MD
TANNER, DENNIS JAMES, MD
1/3/2011
4/3/2009
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
HOUSTON
TX
FORT WORTH TX
ACTIVE
ACTIVE
8/26/2009 None
2/13/2013 None
N/A
N/A
TUCSON
ACTIVE
11/19/2012 None
N/A
2/5/2010 None
N/A
11/17/2008 None
6/4/2013 None
N/A
N/A
AZ
LICENSE
ISSUED
FORTH
WORTH
7/1/2010
1/3/2011
N6059
N4782
N7973
Practice City
Registration
Status of
Practice
Texas
State
License
HOSPITALIST
ACTIVE
ACTIVE
7/15/2010 None
1/26/2011 None
N/A
N/A
2/5/2010 None
N/A
FOOT AND ANKLE,
ORTHOPEDICS
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/5/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
11/11/2009 None
11/14/2011 None
3/12/2012 None
N/A
N/A
N/A
4/9/2010 None
N/A
6/3/2013 None
11/3/2010 None
5/17/2012 None
N/A
N/A
N/A
4/9/2010 None
1/24/2010 None
10/20/2010 None
N/A
N/A
N/A
6/1/2012 None
N/A
5/20/2013 None
N/A
1/3/2011 None
4/13/2009 None
N/A
N/A
HOUSTON
LUBBOCK
PARIS
TX
TX
TX
IL
FAMILY MEDICINE
NEPHROLOGY
AMARILLO
ST. LOUIS
TX
MO
REPRODUCTIVE
ENDOCRINOLOGY
AND INFERTILITY
RADIATION
5/1/2018 ONCOLOGY
GASTROENTEROLOG
1/3/2016 Y
4/3/2014 PEDIATRICS
Page 266 of 300
WATAUGA
DALLAS
DALLAS
TX
TX
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
N8997
N4147
P7861
P0307
P0308
N2312
P5897
P7578
P7714
Physician Name
TANNOUS, ANN FAYEZ, MD
TANNOUS, BEATRICE , MD
TANWAR-AHUJA, MEENA, MD
TAO, JOSHUA DZKUAN, MD
TAPIA, NICOLE MARIE, MD
TARAKJI, MUHAMMAD ANAS, MD
TARASEVICIUTE, AGNE , MD
dicaid
dicaid
Agreement
End Date
Designated)
3/1/2011
8/21/2009
8/30/2013
7/1/2011
7/1/2011
2/6/2009
3/15/2013
3/1/2016
8/21/2014
8/30/2018
7/1/2016
7/1/2016
2/6/2014
3/15/2018
PEDIATRICS
PEDIATRICS
PEDIATRICS
NEONATOLOGY
GENERAL SURGERY
INTERNAL MEDICINE
PEDIATRICS
8/1/2013
8/15/2013
P3256
N8584
N9969
TARBOX, MICHELLE BABB, MD
TARIQ, ZARLISH, MD
TARNAL, VIJAYKUMAR
CHANDRASHEKAR, MD
TARRY, SUSAN ELIZABETH, MD
TARTER, LAURA, MD
5/15/2012
1/18/2011
6/3/2011
P7041
TASSONE, SHAWN ANTHONY, MD
6/14/2013
1/18/2016 UROLOGY
OBSTETRICS AND
P3592
TATAH, ANDREW BAMNJO, MD
P0504
TATE, SHERI L, DO
N6707
TATE, TEMEKA LOTT, MD
6/4/2010
P2381
TATSUI, CLAUDIO ESTEVES, MD
3/1/2012
P6733
P6533
TAUB, JASON SCOTT, MD
TAUSCH, TIMOTHY JAMES, MD
P6926
TAUSEEF, MUHAMMAD ASIF, MD
N7181
TAVAREZ, ROMAN ERIK, MD
P7579
TAYAG, EMILIO CARREON, MD
8/1/2013
NEUROLOGICAL
8/1/2018 SURGERY
P3593
TAYLOR, KRISTAL , MD
6/8/2012
OBSTETRICS AND
6/8/2017 GYNECOLOGY
N9314
TAYLOR, LAKEYSHA, MD
4/1/2011
P1026
TAYLOR, LAURA ANN, MD
9/15/2011
6/8/2012
7/15/2011
5/15/2013
5/1/2013
6/3/2013
7/15/2010
Secondary Specialty
(Self-Designated)
HOSPITALIST
DERMATOPATHOLO
GY
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
ACTIVE
FORT WORTH TX
ACTIVE
AUSTIN
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LUBBOCK
WAVERLY
GALVESTON
GALVESTON
AUSTIN
EMERGENCY
7/15/2016 MEDICINE
INTERNAL MEDICINE
PHYSICAL MED. &
NEUROLOGICAL
3/1/2017 SURGERY
NEUROLOGICAL
5/15/2018 SURGERY
5/1/2018 UROLOGIC SURGERY UNSPECIFIED
6/3/2018 PEDIATRICS
BURNET
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
8/13/2013 None
8/26/2013 None
N/A
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
5/18/2012 None
1/21/2011 None
6/15/2011 None
N/A
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
6/18/2013 None
N/A
6/8/2012 None
N/A
ACTIVE
LICENSE
ISSUED
7/20/2011 None
N/A
6/4/2010 None
N/A
TX
HOUSTON
TX
ACTIVE
3/19/2012 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
5/17/2013 None
5/2/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
6/13/2013 None
N/A
7/15/2010 None
N/A
ACTIVE
8/20/2013 None
N/A
ACTIVE
LICENSE
ISSUED
6/19/2012 None
N/A
4/1/2011 None
N/A
ACTIVE
10/4/2011 None
N/A
HOSPITALIST
DIAGNOSTIC
9/15/2016 RADIOLOGY
Page 267 of 300
3/1/2011
10/2/2009
9/10/2013
7/13/2011
7/12/2011
2/13/2009
3/19/2013
Disciplinary
Status Date
TX
IA
SHREVEPORT LA
NEUROLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
ATLANTA
TX
GA
License
Number
Physician Name
P5574
TAYLOR, MATTHEW TODD, MD
N1469
TAYLOR, SABRINA , MD
N9315
P1826
dicaid
dicaid
Agreement
End Date
Designated)
2/8/2013
10/10/2008
EMERGENCY
10/10/2013 MEDICINE
P7216
TAYLOR, TRAVIS JAY, MD
TE, TAM THI DUC, MD
TECSON, SHEILA LIBERTY DE
CASTRO, MD
TEEGAVARAPU, PURNIMA
SRAVANTI, MD
TEISSLER, HANA , MD
TEIXEIRA, VIVIAN, MD
TEKLE, WONDWOSSEN
GEBREAMANUEL, MD
P6927
TELLA, SWATHI NALLURI, MD
P2382
P7042
TEMPLE, BRIAN A W, MD
TEN PAS, SHERRI L, DO
3/1/2012
6/14/2013
INFECTIOUS
3/1/2017 DISEASES
6/14/2018 NEUROLOGY
P0506
P6928
N4793
TENG, EDWARD CHAO HUNG, MD
TENG, STEFANIE AMY, MD
TENGCO, ROMULO CALATA, MD
7/15/2011
6/3/2013
11/6/2009
N7754
N7356
N8354
N9316
4/1/2011
1/2/2012
9/15/2010
8/2/2010
12/15/2010
4/1/2011
7/1/2013
6/3/2013
P7581
TENGSUPAKUL, SUPATIDA, MD
8/1/2013
N6064
TENNISON, JEGY MARY, MD
4/9/2010
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
7/1/2018 NEUROLOGY
8/1/2018 PEDIATRICS
PHYSICAL MED. &
Disciplinary
Status Date
2/8/2013 None
N/A
EL PASO
TX
ACTIVE
10/15/2008 None
N/A
NEWARK
AUSTIN
NJ
TX
ACTIVE
ACTIVE
4/6/2011 None
2/13/2012 None
N/A
N/A
ACTIVE
9/20/2010 None
N/A
TX
TX
INTERNAL MEDICINE
INTERVENTIONAL
RADIOLOGY
HARLINGEN
CRITICAL CARE
ANESTHESIOLOGY
DALLAS
ACTIVE
ACTIVE
ACTIVE
8/5/2010 None
12/21/2010 None
4/18/2011 None
N/A
N/A
N/A
TX
ACTIVE
7/25/2013 None
N/A
TX
ACTIVE
6/5/2013 None
N/A
SLEEP MEDICINE
TYLER
TX
TX
ACTIVE
ACTIVE
3/28/2012 None
6/19/2013 None
N/A
N/A
TEXARKANA
AUSTIN
HAMILTON
AR
TX
NJ
ACTIVE
ACTIVE
ACTIVE
8/1/2011 None
6/20/2013 None
12/23/2009 None
N/A
N/A
N/A
PEDIATRIC
INFECTIOUS
DISEASE
MCALLEN
TX
ACTIVE
8/2/2013 None
N/A
ACTIVE
4/30/2010 None
N/A
FAMILY PRACTICE
CAMP
LEJEUNE
NC
ACTIVE
9/22/2008 None
N/A
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
EL PASO
N1177
TENNYSON, TYRA DAREECE, MD
8/29/2008
P3258
N3342
TERASAKI, ORELIA RAMIREZ, MD
TERLECKI, RYAN PATRICK, MD
5/15/2012
5/29/2009
TEXAS CITY
DALLAS
TX
TX
ACTIVE
ACTIVE
5/17/2012 None
6/4/2009 None
N/A
N/A
N2837
TERLECKI, THERESA MAROSI, MD
4/3/2009
5/29/2014 UROLOGY
EMERGENCY
4/3/2014 MEDICINE
DALLAS
TX
ACTIVE
4/17/2009 None
N/A
N1178
TERRERI, ANTHONY ANDREW, MD
8/29/2008
8/29/2013 RADIOLOGY
ACTIVE
9/8/2008 None
N/A
P1827
TERRY, AARON WADE, MD
RICHARDSON TX
RANDOLPH
AFB
TX
ACTIVE
1/26/2012 None
N/A
1/2/2012
Page 268 of 300
License
Number
N5430
Physician Name
TESORERO TENGCO, MAFALDA
DIAZ, MD
N7755
N4152
TESTA, GIULIANO , MD
TETTEH, SHIRLEY , MD
N6712
TEUNIS, CANDICE BRAERMAN, MD
P4520
TEWARI, PRITI, MD
P1700
P7218
TEWARI, SHALINI, MD
THACKER, ANMONA S, MD
N9655
THAI, QUOC-ANH, MD
L4146
N4794
THAMMASITBOON, SATID, MD
THAMMASITHIBOON, SANDY, MD
N7590
P7716
P1238
P0679
THAPAR, VANDANA C, MD
THARIAN, DIMPLE THARA, MD
THAROO, ANAM REHMAN, MD
THATIKONDA, CHANDANA, MD
N7009
N4795
dicaid
dicaid
Agreement
End Date
Designated)
2/5/2010
9/15/2010
8/21/2009
6/4/2010
9/17/2012
12/15/2011
7/1/2013
5/2/2011
2/4/2011
11/6/2009
Practice City
2/5/2015 PEDIATRICS
TRANSPLANT
SURGERY
ORTHOPEDIC
6/4/2015 SURGERY
SURGERY
PEDIATRIC
HEMATOLOGY/ONCOL
9/17/2017 OGY
GERIATRIC
MEDICINE (INTERNAL
7/1/2018 PEDIATRICS
NEUROLOGICAL
5/2/2016 SURGERY
PEDIATRIC CRITICAL
2/4/2016 PEDIATRICS
CARE MEDICINE
PEDIATRIC CRITICAL
CARE MEDICINE
FAMILY PRACTICE
FAMILY MEDICINE
INTERNAL MEDICINE
RADIATION
ONCOLOGY
INTERNAL MEDICINE
RADIATION
ONCOLOGY
HOSPITALIST
8/27/2010
8/15/2013
10/17/2011
8/1/2011
8/27/2015
8/15/2018
10/17/2016
8/1/2016
THATIKONDA, SRIVANI, MD
THAUNG, HTIN AUNG, MD
7/1/2010
11/6/2009
7/1/2015
11/6/2014
N7591
N8586
THAWANI, NITIKA, MD
THENAPPAN, MAHESH V, MD
8/27/2010
1/18/2011
8/27/2015
1/18/2016
P2070
THENGANATT, MARY ANN, MD
2/1/2012
P0934
9/1/2011
N6713
THET, ZEYAR , MD
THIBODEAU, JENNIFER TAYLOR,
MD
2/1/2017 NEUROLOGY
INFECTIOUS
9/1/2016 DISEASES
6/4/2010
6/4/2015 CARDIOLOGY
N7182
P3464
THIRUNARAYANAN, SUPRIYA , MD
THOMAS MOHAN, REENA , MD
7/15/2010
6/1/2012
Secondary Specialty
(Self-Designated)
CHICAGO
DALLAS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
IL
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/5/2010 None
N/A
9/22/2010 None
9/1/2009 None
N/A
N/A
6/4/2010 None
N/A
HOUSTON
TX
ACTIVE
9/19/2012 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
1/2/2012 None
7/16/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
5/5/2011 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
HOUSTON
AMARILLO
TX
TX
KILLEEN
TX
MONAHANS
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
KYLE
MOVEMENT
DISORDERS
NY
TX
TX
INTERNAL MEDICINE BROOKLYN
PEDIATRICS
2/14/2011 None
11/24/2009 None
SEE
PREVIOUS
9/14/2010 ORDER
8/22/2013 None
10/27/2011 None
8/5/2011 None
N/A
N/A
7/1/2010 None
11/19/2009 None
N/A
N/A
ACTIVE
ACTIVE
8/31/2010 None
1/24/2011 None
N/A
N/A
NY
ACTIVE
2/15/2012 None
N/A
NY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/7/2011 None
N/A
6/4/2010 None
N/A
7/15/2010 None
6/27/2012 None
N/A
N/A
INTERNAL MEDICINE
INTERNAL MEDICINE
7/15/2015 NEUROLOGY
Page 269 of 300
HOUSTON
TX
8/27/2010
N/A
N/A
N/A
License
Number
P1601
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
12/1/2011
P7219
P3084
P4619
THOMAS, ABEY KOZHIMANNIL, MD
THOMAS, ABRAHAM PALAMOOTIL,
MD
THOMAS, ANSA MARIN, MD
THOMAS, ASHA J, MD
7/1/2013
5/1/2012
10/1/2012
7/1/2018 NEUROLOGY
5/1/2017 PEDIATRICS
N6067
THOMAS, ELIZABETH RACHEL, DO
4/9/2010
P0799
P1146
P6736
THOMAS, KATHERINE ANNE, MD
THOMAS, MARTHA DIANNA, MD
THOMAS, NAJA MARI, MD
N7183
THOMAS, RYAN BLAINE, MD
P4912
N9141
P3259
P2795
THOMAS, SALY, MD
THOMAS, SANDHYA SARA, MD
THOMAS, SIBI PHILIPOSE, DO
THOMAS, STEPHANIE, MD
P3675
THOMPSON, BOBBYE JO, MD
N6715
THOMPSON, ELISSA COOKE, MD
8/15/2011
10/3/2011
5/15/2013
7/15/2010
7/15/2015
11/15/2012
3/15/2011
5/15/2012
4/2/2012
11/15/2017
3/15/2016
5/15/2017
4/2/2017
6/15/2012
6/15/2017
6/4/2010
N7756
N9318
THOMPSON, J DAVID , MD
THOMPSON, STERLING W, MD
9/15/2010
4/1/2011
N7499
THONGTRANGAN, ISSADA, MD
8/16/2010
N7975
THORLEY, RODNEY R, MD
10/15/2010
N9142
THORSON, MATTHEW G, MD
3/15/2011
N4160
THOTA, GOPIKIRAN , MD
8/21/2009
N4801
THRASH, DUSTIN BRECK, MD
THUMMALA, SUNIL KUMAR REDDY,
MD
11/6/2009
N9970
4/9/2015 PEDIATRICS
6/3/2011
ORTHOPEDIC
SURGERY
OBSTETRICS AND
GYNECOLOGY
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
URGENT CARE
MEDICINE
6/4/2015 CARDIOLOGY
PEDIATRIC
ORTHOPEDIC
SURGERY OF THE
8/16/2015 SPINE
PHYSICAL MED. &
Secondary Specialty
(Self-Designated)
NEPHROLOGY
VASCULAR
NEUROLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
12/12/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/8/2013 None
5/17/2012 None
11/14/2012 None
N/A
N/A
N/A
4/9/2010 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
8/19/2011 None
10/18/2011 None
5/21/2013 None
N/A
N/A
N/A
SAN ANTONIO TX
ACTIVE
7/23/2010 None
N/A
NEPHROLOGY
DALLAS
TX
HOUSTON
TX
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DERMATOLOGY
GALVESTON
HOUSTON
TX
DALLAS
TX
FORT WORTH TX
PEDIATRICS
GAINESVILLE
SURGERY
TX
ORTHOPEDIC
SURGERY
GONZALES
ORTHOPEDIC
SURGERY
TX
PLANO
TX
CHESTERFIEL
D
MO
ORAL &
MAXILLOFACIAL
8/21/2014 SURGERY
CEDAR PARK
INTERNAL MED - PREV
11/6/2014 MED
INTERNAL MEDICINE
6/3/2016 NEUROLOGY
Page 270 of 300
TX
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
6/19/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
9/22/2010 None
4/6/2011 None
N/A
N/A
ACTIVE
8/25/2010 None
N/A
10/21/2010 None
N/A
3/15/2011 None
N/A
8/26/2009 None
N/A
11/18/2009 None
N/A
6/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
11/23/2012
3/23/2011
5/25/2012
4/19/2012
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
7/15/2018 GLAUCOMA
OPHTHALMOLOGY
4/1/2013
Practice City
Registration
Status of
Practice
Texas
State
License
P7362
P6098
THUNG, ELAINE GIOKLAN, MD
THURMAN, JERRY LEE JR, MD
N6716
P0309
THYSSEN, ELIZABETH ANN, DO
TIDROSKI, JENNIFER EVANS, DO
N3349
TIERNEY, RYAN MENZIES , MD
5/29/2009
6/4/2015 PEDIATRICS
7/1/2016 PEDIATRICS
RADIATION
5/29/2014 ONCOLOGY
N6718
N4802
N3350
6/4/2010
11/6/2009
5/29/2009
N7885
TIEU, KENNETH KHIEM, MD
TIGLEY, THOM JUEL ESPINA, MD
TILLEY, MELISSA MAE, MD
TINIO, FREDERICK GUTIERREZ,
MD
10/1/2010
N8862
TINSLEY, AMANDA SUZANNE, DO
2/15/2011
ORTHOPEDIC
TRAUMA
TX
HOSPITALIST
TX
6/4/2010
7/1/2011
P0507
TINUBU, BABA JIDE MOHAMED, MD
7/15/2011
EMERGENCY
2/15/2016 MEDICINE
ORTHOPEDIC
7/15/2016 SURGERY
P2168
P5486
2/10/2012
2/1/2013
2/10/2017 RADIOLOGY
P1701
TINUBU, SANYA, MD
TIRGAN, NIMA, MD
TISCARENO-GRAJEDA, LETICIA
ILIANA, MD
12/15/2011
N5436
TISDALE, BERNARD ALVAN, MD
2/5/2010
N9000
P6288
P2169
TIWANA, G PAUL SINGH, MD
TOBLER, KENNETH SCOTT, MD
TOLEDO, CLAUDIO CONSTANTINO,
MD
RADIATION
2/5/2015 ONCOLOGY
ORAL &
MAXILLOFACIAL
3/1/2016 SURGERY
N6719
TOLIA, DEEPTI M, DO
3/1/2011
4/12/2013
2/10/2012
6/4/2010
N6720
TOLIA, VEERAL N, MD
6/4/2010
P2797
TOMAJIAN, SAMIR ABDOU, MD
TOMANEC, ALAINYA VOLLMERING,
MD
4/2/2012
P7363
7/15/2013
HOSPITALIST
NEONATOLOGY
6/4/2015 PEDIATRICS
6/4/2015 PEDIATRICS
EMERGENCY
7/15/2018 MEDICINE
NEONATALPERINATAL
MEDICINE
EMERGENCY
MEDICINE
Page 271 of 300
HOUSTON
HOUSTON
TX
TX
EASTLAND
TX
AUSTIN
TX
TAMPA
HOUSTON
FL
TX
HOUSTON
EL PASO
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
7/19/2013 None
4/29/2013 None
N/A
N/A
6/4/2010 None
7/11/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/9/2009 None
N/A
6/4/2010 None
2/2/2010 None
8/27/2009 None
N/A
N/A
N/A
10/1/2010 None
N/A
2/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
7/20/2011 None
N/A
2/10/2012 None
2/6/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
12/20/2011 None
N/A
2/5/2010 None
N/A
DALLAS
TEMPLE
TX
TX
ACTIVE
ACTIVE
4/25/2011 None
4/17/2013 None
N/A
N/A
BULVERDE
TX
ACTIVE
LICENSE
ISSUED
2/17/2012 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
4/2/2012 None
N/A
7/15/2013 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
P5140
P5140
P5140
N9785
Physician Name
TOMLINSON, TRACY MICHELLE,
MD
MD
MD
TOMOYE, EDWARD O, DO
N7185
N8068
TOMSIC, KEVIN LEE, MD
TONG, CARL WEI-CHAN, MD
N8251
P0680
TONKOVIC-CAPIN, VISESLAV, MD
TOOR, NADIA NAEEM, MD
TORO-SERRA, RAFAEL ORLANDO,
MD
N9001
P4720
N4803
P5242
TORREALBA, JOSE RAMON, MD
TORRES BARJA, IUMY, MD
TORRES SANTOS, JUAN
EDUARDO, MD
N4164
TORRES, JAIME ENRIQUE , MD
P1239
TORRES, JOEL , MD
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
12/17/2012
OBSTETRICS AND
12/17/2012
OBSTETRICS AND
12/17/2012
5/16/2011
7/15/2010
10/29/2010
12/1/2010
8/1/2011
3/1/2011
10/15/2012
11/6/2009
1/4/2013
8/21/2009
10/17/2011
P7864
TORRES, MARIA C, MD
8/30/2013
N6069
TORREZ, HEATHER DAWN, MD
N7886
TOTOE, ROBERT ASAMOAH, MD
P1702
TOUADROUS, AMEER, MD
N9319
P5899
N7661
TOVAR, MIGUEL ANGEL, DO
TOWBIN, NANCY ANDES, MD
TOWNSEND, MONICA ELLEN, MD
4/1/2011
3/15/2013
9/1/2010
P5744
TRACY, CHRISTINE ANNETTE, DO
3/1/2013
4/9/2010
10/1/2010
12/15/2011
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
ACTIVE
6/17/2011 None
N/A
ACTIVE
ACTIVE
7/27/2010 None
11/5/2010 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
12/30/2010 None
8/29/2011 None
N/A
N/A
3/1/2011 None
N/A
TX
ACTIVE
ACTIVE
10/18/2012 None
12/4/2009 None
N/A
N/A
TX
ACTIVE
1/8/2013 None
N/A
SAN ANTONIO TX
ACTIVE
9/3/2009 None
N/A
EL PASO
TX
ACTIVE
10/24/2011 None
N/A
VICTORIA
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/5/2013 None
N/A
4/9/2010 None
N/A
10/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
2/27/2012 None
N/A
4/1/2011 None
4/8/2013 None
9/6/2010 None
N/A
N/A
N/A
ACTIVE
4/29/2013 None
N/A
INFECTIOUS
DISEASES
HEAD AND NECK
SURGERY
ANATOMIC/CLINICAL
PATHOLOGY
DALLAS
1/4/2018 PEDIATRICS
HOUSTON
EMERGENCY
10/17/2016 MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
EMERGENCY
4/9/2015 MEDICINE
OBSTETRICS AND
OBSTETRICS AND
4/1/2016 GYNECOLOGY
EMERGENCY
3/1/2018 MEDICINE
FULLERTON
TEXARKANA
EMERGENCY
MEDICINE
Page 272 of 300
Disciplinary
Status Date
12/17/2012 None
NACOGDOCH
ES
TX
TX
DERMATOPATHOLO
GY
ANATOMIC
Registration
Status Date
Disciplinary
Status of
Texas
License
CA
TX
FORT WORTH TX
License
Number
N1480
N9002
N7503
Physician Name
TRAMPOTA, SARAH ELIZABETH,
MD
TRAN, ALEX MINH NGUYET, MD
TRAN, CHAU MY, MD
dicaid
dicaid
Agreement
End Date
Designated)
10/10/2008
8/21/2009
ALLERGY AND
TRAN, DAT QUOC, MD
P2799
TRAN, KY DIEU, MD
N3357
TRAN, MACLONG TONY, MD
5/29/2009
P6737
P7584
N7504
5/15/2013
8/1/2013
8/16/2010
N1482
TRAN, THIEN VAN, MD
TRAN, TUNG MINH BA, MD
TRANG, TONY , MD
TRAN-NGUYEN, JACKLYN
BICHTHUY, MD
P3466
TRAORE, AMINATA , MD
N1928
TRAZZERA, MELISSA LILLYAN, DO
P0313
3/1/2011
8/16/2010
N4167
4/2/2012
10/10/2008
6/1/2012
12/12/2008
7/1/2011
10/21/2008 None
N/A
TAMPA
FL
ACTIVE
ACTIVE
3/22/2011 None
8/31/2010 None
N/A
N/A
PEDIATRICS,
ALLERGY &
IMMUNOLOGY
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
9/1/2009 None
N/A
4/2/2012 None
N/A
TX
ACTIVE
6/4/2009 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
5/20/2013 None
8/8/2013 None
8/26/2010 None
N/A
N/A
N/A
CA
ACTIVE
LICENSE
ISSUED
12/3/2008 None
N/A
6/1/2012 None
N/A
ACTIVE
2/9/2009 None
N/A
DALLAS
WICHITA
FALLS
CONROE
HOUSTON
REDWOOD
CITY
TX
N1483
N4805
TREVINO, EDGAR ALBERTO, MD
11/6/2009
M3769
P5307
TREVINO, JESSICA MARIE, MD
TREVINO, MARK JOSEPH, MD
2/8/2013
1/15/2013
P7585
TREVINO-RAMIREZ, KARLA , MD
8/1/2013
P5487
TRICINELLA, LINDSEY TANNER, DO
2/1/2013
N6723
TRIFUNOVIC, BORIVOJE, MD
6/4/2010
Disciplinary
Status Date
ACTIVE
Registration
Status Date
SAN ANTONIO TX
6/1/2017 RADIOLOGY
Practice City
Disciplinary
Status of
Texas
License
PHYSICAL MED. &
REHABILITATION
EMERGENCY
5/29/2014 MEDICINE
OBSTETRICS &
GYNECOLOGICAL
5/15/2018 SURGERY
TREEN, BEN MARCUS, MD
TREMONT LUKATS, IVO
WIGBERTO, MD
10/10/2008
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
DERMATOLOGIC
SURGERY
DOTHAN
AL
ACTIVE
7/25/2011 None
N/A
NEURO-ONCOLOGY
HOUSTON
TX
ACTIVE
1/6/2009 None
SEE
PREVIOUS
11/6/2009 ORDER
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
2/14/2013 None
2/13/2013 None
N/A
N/A
8/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
2/18/2013 None
N/A
6/4/2010 None
N/A
SPORTS MEDICINE
(FAMILY PRACTICE)
GASTROENTEROLOG
2/8/2018 Y
Page 273 of 300
LICENSE
ISSUED
TX
TX
11/9/2009
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
PULMONARY
CRITICAL CARE
N7976
TRINH, CINDY , MD
10/15/2010
10/15/2015 MEDICINE
INTERNAL MEDICINE
P6537
TRINH, TAN N, MD
5/1/2013
PSYCHOSOMATIC
P6538
TRINIDAD, ANTOLIN C, MD
5/1/2013
5/1/2018 PSYCHIATRY
MEDICINE
GASTROENTEROLOG
P2800
TRIVEDI, APURVA NAVIN, MD
4/2/2012
4/2/2017 Y
INTERNAL MEDICINE
PEDIATRIC
ANESTHESIOLOGY
P7221
TRIVEDI, PREMAL MADHUKAR, MD
7/1/2013
(PEDS)
EMERGENCY
P2548
TRONCOSO, ALEXIS B, MD
3/15/2012
3/15/2017 MEDICINE
P2549
TROTTA, ADAM LEVI, MD
3/15/2012
GASTROENTEROLOG
J1149
TROTTER, JAMES FORD, MD
4/3/2009
4/3/2014 Y
HEPATOLOGY
PLASTIC &
PLASTIC SURGERY
RECONSTRUCTIVE
WITHIN THE HEAD
N6725
TROVATO, MATTHEW JOHN, MD
6/4/2010
6/4/2015 SURGERY
AND NECK
TROWBRIDGE, ALLISON MERNER,
EMERGENCY
N6726
MD
6/4/2010
6/4/2015 MEDICINE
TROXCLAIR, SEAN KRISTOFOR ,
CRITICAL CARE
N3359
MD
5/29/2009
5/29/2014 MEDICINE
INTERNAL MEDICINE
TRUCKENBROD, JAYNE SUZANNE,
P7718
DO
8/15/2013
HOSPITALIST
P3261
TRUONG, HUNG HOANG, MD
5/15/2012
P5900
TRUONG, PHU THIEN, DO
3/15/2013
P0801
TRUONG, TAM MINH, MD
8/15/2011
TRAUMATIC
N2852
TRUSSELL, JOSHUA KYLE, MD
4/3/2009
SURGICAL
N4169
TRUTY, MARK JOSEPH, MD
8/21/2009
8/21/2014 ONCOLOGY
GENERAL SURGERY
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
N8252
TRUUMEES, EERIC, MD
12/1/2010
12/1/2015 SURGERY
SPINE
THORACIC
CARDIOVASCULAR
TRAUMATIC
N1192
TSAI, PETER I-HSUAN, MD
8/29/2008
8/29/2013 SURGERY
SURGERY
PLASTIC &
RECONSTRUCTIVE
N4807
TSAI, TSUNG-LIN ROGER, MD
11/6/2009
11/6/2014 SURGERY
PLASTIC SURGERY
Page 274 of 300
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
GALVESTON
TX
ACTIVE
ACTIVE
10/28/2010 None
5/14/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
5/7/2013 None
N/A
BETHESDA
MD
ACTIVE
4/6/2012 None
N/A
HOUSTON
TX
7/9/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
3/15/2012 None
3/19/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
4/9/2009 None
N/A
6/4/2010 None
N/A
6/4/2010 None
N/A
6/9/2009 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
TYLER
TX
ACTIVE
AUSTIN
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
8/26/2013
6/20/2012
3/21/2013
8/18/2011
None
None
None
None
N/A
N/A
N/A
N/A
FORT WORTH TX
GREENVILLE
TX
ACTIVE
4/20/2009 None
N/A
HOUSTON
TX
ACTIVE
9/17/2009 None
N/A
AUSTIN
TX
ACTIVE
2/9/2011 None
N/A
HOUSTON
TX
ACTIVE
9/5/2008 None
N/A
ACTIVE
1/11/2010 None
N/A
License
Number
Physician Name
N9656
TSE, GLADYS, MD
N6728
TSENG, TIMOTHY YU-TING, MD
P0935
P6290
TSOURMAS, JESSICA E, MD
TSUI, ANNIE YEEWEN, DO
N7013
TU, YEN-TE, MD
TUAMOKUMO, TIMI SENA-KOLA,
MD
N8864
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
OBSTETRICS AND
5/2/2011
5/2/2016 SURGERY
GYNECOLOGY
6/4/2010
9/1/2011
4/12/2013
7/1/2010
2/15/2011
6/15/2011
OBSTETRICS AND
DIAGNOSTIC
6/4/2015 RADIOLOGY
OBSTETRICS AND
6/4/2015 GYNECOLOGY
TUCKER, KEELIE RENEE, MD
N6729
TUCKMAN, GLENN ANDREW, MD
6/4/2010
N6730
TUDELA, CARMEN M, MD
6/4/2010
N7014
TUJIOS, SHANNAN RENEE, MD
7/1/2010
P7587
P0508
TULBERT, BRIAN WESLEY, DO
TUMMALA, JAGDISH, MD
8/1/2013
7/15/2011
7/1/2015 HEPATOLOGY
EMERGENCY
8/1/2018 MEDICINE
N9657
N1931
TUMYAN, ANNA, MD
TUNSTALL, STANLEY RAY, MD
5/2/2011
12/12/2008
P0936
TUNUGUNTLA, HARI PRIYA, MD
N4811
TUREK, JOSEPH WILLIAM, MD
11/6/2009
N4812
P7719
TURER, ASLAN TEYFIK, MD
TURK, CLIFFORD PERCY, MD
11/6/2009
8/15/2013
P0804
TURNBOW, BENJAMIN , MD
8/15/2011
P6291
P3600
TURNER, AMANDA SUE, MD
TURNER, BARBARA JEAN, MD
4/12/2013
6/8/2012
9/1/2011
9/1/2016 PEDIATRICS
PEDIATRIC
CARDIOTHORACIC
11/6/2014 SURGERY
INTERVENTIONAL
ORTHOPEDIC
8/15/2016 TRAUMA
Disciplinary
Status Date
5/16/2011 None
N/A
6/4/2010 None
N/A
AUSTIN
TX
ROUND ROCK TX
ACTIVE
ACTIVE
9/13/2011 None
4/18/2013 None
N/A
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
7/16/2010 None
N/A
2/15/2011 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
7/21/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
8/2/2013 None
7/20/2011 None
N/A
N/A
5/2/2011 None
2/9/2009 None
N/A
N/A
ACTIVE
9/8/2011 None
N/A
NC
ACTIVE
11/16/2009 None
N/A
TX
ACTIVE
ACTIVE
11/16/2009 None
8/20/2013 None
N/A
N/A
ORTHOPEDIC
SURGERY
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/22/2011 None
N/A
4/12/2013 None
6/19/2012 None
N/A
N/A
OBSTETRICS &
GYNECOLOGICAL
SURGERY
FORT WORTH TX
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
6/4/2015 UROLOGY
CHILD AND
ADOLESCENT
9/1/2016 PSYCHIATRY
4/12/2018 NEUROLOGY
EMERGENCY
7/1/2015 MEDICINE
PHYSICAL MED. &
P0146
Practice City
Registration
Status of
Practice
Texas
State
License
AMARILLO
TX
TX
GASTROENTEROLOG
Y
FORT WORTH TX
HOUSTON
TX
LONGVIEW
TX
PEDIATRICS,
CARDIOLOGY
DURHAM
Page 275 of 300
GALVESTON
SAN ANTONIO TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N6074
TVERYE, ELLIOT, MD
4/9/2010
P5749
TWIGGS, LEO BROOKHART, MD
3/1/2013
N9489
4/15/2011
N6732
TWILLEY, RUSH , MD
TWOMBLEY, KATHERINE
ELIZABETH, MD
N6733
N3361
TYAGI, ASHOK KUMAR, DO
TYNDALL, MIRIAM LEAH, MD
6/4/2010
5/29/2009
5/29/2014
N6734
TYNER, RYAN PATRICK, MD
6/4/2010
P7365
TYO, STEPHANIE RENEE, MD
6/4/2010
7/15/2013
GYNECOLOGIC
3/1/2018 ONCOLOGY
EMERGENCY
4/15/2016 MEDICINE
PEDIATRIC
6/4/2015 NEPHROLOGY
TYSON, GEORGE HART III, MD
5/2/2011
N7015
P3471
N2326
P5750
7/1/2010
6/1/2012
2/6/2009
3/1/2013
P1941
UBAID, FARAH, MD
UCHIYAMA, ROBERT CALVIN, MD
UDDIN, FATEMA SULTANA, MD
UDDIN, NASEEM , MD
UDEOZO, OBIORA IGWEDUMMA,
MD
N8153
UFEARO, HILARY IKENNA, MD
11/15/2010
N9789
5/16/2011
P2801
UFFMAN, JOHN KENNETH, MD
UGBARUGBA, EMMANUEL
EZIKERU, MD
N8865
P7222
UGHWANOGHO, EJOVI, MD
UHEGWU, LINDA NWAOMA, MD
2/15/2011
7/1/2013
ORTHOPEDIC
SURGERY OF THE
2/15/2016 SPINE
N4814
UKPEDE, JOHNSON AKPOBA, MD
11/6/2009
P1424
ULLAH, SANA, MD
4/2/2012
11/4/2011
EMERGENCY
7/1/2015 MEDICINE
3/1/2018 PATHOLOGY
CRITICAL CARE
HEMATOLOGY/ONCOL
11/15/2015 OGY
Practice City
SAN ANTONIO TX
PEDIATRICS
PULMONARY
CRITICAL CARE
MEDICINE
GYNECOLOGY
N9658
1/17/2012
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
IRVING
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
4/9/2010 None
N/A
3/1/2013 None
N/A
4/25/2011 None
N/A
6/4/2010 None
N/A
6/4/2010 None
6/12/2009 None
N/A
N/A
6/4/2010 None
N/A
GLADEWATER TX
ACTIVE
7/22/2013 None
N/A
HOUSTON
TX
ACTIVE
5/10/2011 None
N/A
INTERNAL MEDICINE
DALLAS
DALLAS
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/27/2010
6/7/2012
2/17/2009
3/8/2013
None
None
None
None
N/A
N/A
N/A
N/A
NEPHROLOGY
MI
ACTIVE
2/3/2012 None
N/A
MN
ACTIVE
12/27/2010 None
N/A
6/1/2011 None
N/A
4/2/2012 None
N/A
2/15/2011 None
7/26/2013 None
N/A
N/A
ACTIVE
11/16/2009 None
N/A
ACTIVE
11/11/2011 None
N/A
TRAUMATIC
SURGERY
ANN ARBOR
INTERNAL MEDICINE ST CLOUD
5/16/2016 PEDIATRIC SURGERY GENERAL SURGERY FORT WORTH TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
ACTIVE
HOSPITALIST
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Page 276 of 300
ACTIVE
LICENSE
ISSUED
LITTLE ROCK
AR
License
Number
P6740
N7363
N1932
Physician Name
P5009
ULLMAN, NACHMAN , DO
UMAIR, SONOBER, MD
UMBER, AFIA , MD
UMBERHANDT, ROBERT CECIL,
MD
N7364
UMER, SARWAT, MD
N5446
P4721
UNDAVIA, SAMIR SURESH, MD
UNDERWOOD, JOEL RALEY, MD
P6539
UNNI, NISHA, MD
N2858
UNZUETA-HERNANDEZ, MARY
RICHELLE, MD
P4522
UPPAL, PRIYANKA, MD
N6737
UPPUTURI, NEELIMA, MD
N9790
N8588
P6741
N8254
URAGODA, LALITH CHRISANTHA,
MD
URANGA, JOE ANTHONY, MD
URIBE, EDUARDO , MD
URIZAR, JUAN CARLOS, MD
N6738
URREA-BOTERO, GABRIEL
ALBERTO, MD
N6739
N4816
N1194
URRUTIA, ALLISON ANNE, MD
USHER, ELENITA LORENI, MD
UY, CESAR CHUA JR, MD
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRIC
EMERGENCY
5/15/2013
8/2/2010
8/2/2015 PEDIATRICS
12/12/2008
PEDIATRIC
11/30/2012
PEDIATRIC
8/2/2010
FACIAL PLASTIC
2/5/2010
2/5/2015 SURGERY
10/15/2012
HEMATOLOGY/ONCOL
5/1/2013
5/1/2018 OGY
4/3/2009
9/17/2012
6/4/2010
5/16/2011
1/18/2011
5/15/2013
12/1/2010
6/4/2010
4/3/2014 PSYCHIATRY
INFECTIOUS
9/17/2017 DISEASES
PULMONARY
CRITICAL CARE
5/16/2016 MEDICINE
Practice City
7/16/2013 None
8/5/2010 None
12/19/2008 None
N/A
N/A
N/A
ORTHOPEDICS
DALLAS
TX
ACTIVE
12/3/2012 None
N/A
RHEUMATOLOGY
DALLAS
TX
9/20/2010 None
N/A
TYLER
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/5/2010 None
11/20/2012 None
N/A
N/A
OTOLARYNGOLOGY
TX
CHILD AND
ADOLESCENT
PSYCHIATRY
SAN ANTONIO TX
ACTIVE
5/13/2013 None
N/A
ACTIVE
4/8/2009 None
N/A
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
9/27/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/3/2011
1/27/2011
5/21/2013
2/3/2011
BOWLING
GREEN
KY
HARLINGEN
TX
NEUROPSYCHIATRY SAN ANTONIO TX
UYSAL, ASKIN, MD
9/17/2012
N9144
P3473
UZOWULU, OBINNA CHIMEZIE, MD
VADDEMPUDI, VIDYA, MD
3/15/2011
6/1/2012
Disciplinary
Status Date
ACTIVE
ACTIVE
ACTIVE
SLEEP MEDICINE
P4523
Registration
Status Date
Disciplinary
Status of
Texas
License
PEDIATRIC CRITICAL
CARE MEDICINE
CLEVELAND
OH
HOUSTON
TX
HOSPITALIST
FORT WORTH TX
INTERNAL MEDICINE
OBSTETRICS AND
6/4/2015 GYNECOLOGY
PULMONARY
CRITICAL CARE
9/17/2017 MEDICINE
6/4/2010
11/6/2009
8/29/2008
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
GERIATRICS
GENERAL PRACTICE
None
None
None
None
N/A
N/A
N/A
N/A
HOSPITALIST
ODESSA
PALESTINE
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
SLEEP MEDICINE
WEST
MONROE
LA
ACTIVE
9/27/2012 None
N/A
ACTIVE
ACTIVE
3/28/2011 None
6/8/2012 None
N/A
N/A
HOSPITALIST
Page 277 of 300
6/4/2010 None
N/A
6/4/2010 None
12/9/2009 None
9/9/2008 None
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P2073
VADYALA, VIKRAM REDDY, MD
2/1/2012
P2074
VAHDAT, KHASHAYAR KASH, MD
2/1/2012
N5448
VAID, REENA MOZA, MD
2/5/2010
P2552
VAKEY, DAVID KIRK, MD
3/15/2012
2/5/2015 PEDIATRICS
EMERGENCY
3/15/2017 MEDICINE
N7595
N4176
P0884
8/27/2010
8/21/2009
8/26/2011
N1198
VALAVALKAR, SUBHASHINI S, MD
VALDES ROQUE, ANA I , MD
VALDES, PAVEL , MD
VALDEZ ARROYO, SHERLEY
ROSE, MD
8/29/2008
8/29/2013 NEUROLOGY
N6741
N4817
N7506
P1603
VALENTIN, REUBEN JR, MD
VALENZUELA, EDUARD , MD
VALICEK, RYAN ALAN, MD
VALLABHAJOSULA, SAILAJA, MD
6/4/2010
11/6/2009
8/16/2010
12/1/2011
6/4/2015
11/6/2014
8/16/2015
12/1/2016
N3365
VALLANCE, KELLY LOREN , MD
5/29/2009
P1703
VALLEJO-MANZUR, JOSE
FEDERICO, MD
VALLEJO-NIETO, MARIA
ALEJANDRA, MD
P5901
VAN BOVEN, ROBERT WAYNE, MD
3/15/2013
P1425
N7507
VAN HORNE, ANNE, MD
VAN PRAAG, CINDY A, MD
11/4/2011
8/16/2010
P6742
N4819
P1027
VAN WINKLE, JENNY LEIGH, MD
VANCE, AWAIS ZAFAR, MD
VANCE, DAVID ALLEN, MD
5/15/2013
11/6/2009
9/15/2011
N2328
P2555
P6743
VANDEPUTTE, NICHOLE
JEANETTA, MD
VANDERVELDT, HENDRIKUS
STEPHEN, MD
2/6/2009
12/15/2011
3/15/2012
5/15/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
INTERNAL MEDICINE
PEDIATRICS
HOUSTON
TX
ARLINGTON
TX
SAN ANTONIO TX
GENERAL PRACTICE
INTERNAL MEDICINE NEPHROLOGY
PEDIATRICS
RHEUMATOLOGY
INTERNAL MEDICINE SUGARLAND TX
INTERNAL MEDICINE
PEDIATRIC
HEMATOLOGY/ONCOL
5/29/2014 OGY
FORT WORTH TX
PULMONARY
CRITICAL CARE
2/6/2014 MEDICINE
TX
FAMILY PRACTICE
3/15/2018 NEUROLOGY
OBSTETRICS AND
OBSTETRICS AND
11/6/2014 RADIOLOGY
OBSTETRICS &
GYNECOLOGICAL
3/15/2017 SURGERY
GASTROENTEROLOG
5/15/2018 Y
INTERNAL MEDICINE
Page 278 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
2/20/2012 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
3/23/2012 None
N/A
8/27/2010 None
8/31/2009 None
9/6/2011 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
9/17/2008 None
N/A
6/4/2010
11/25/2009
8/19/2010
12/28/2011
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
6/4/2009 None
N/A
ACTIVE
3/26/2009 None
N/A
AUSTIN
TX
ACTIVE
12/20/2011 None
N/A
LAKEWAY
TX
ACTIVE
4/3/2013 None
N/A
HOUSTON
TUCSON
TX
AZ
ACTIVE
ACTIVE
12/5/2011 None
9/13/2010 None
N/A
N/A
PROVIDENCE RI
SAN ANGELO TX
ACTIVE
ACTIVE
ACTIVE
6/6/2013 None
11/16/2009 None
9/21/2011 None
N/A
N/A
N/A
SAN ANTONIO TX
ACTIVE
3/26/2012 None
N/A
SAN ANTONIO TX
ACTIVE
7/8/2013 None
N/A
License
Number
Physician Name
P7223
VANG, NA LY, DO
P7224
VANGA, NAVEEN , MD
N8739
P3262
VANGA, SHILPA, MD
VANGURU, RAGHUVEER, MD
P2077
VARGA, MARIANA GEORGETA, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/1/2013
7/1/2013
2/4/2011
5/15/2012
2/1/2012
2/1/2017 NEUROLOGY
P1426
N1937
VARGAS, ALBERTO , MD
VARGAS, DANIEL , MD
P7045
VARGHEES, SEEMA SUSAN, MD
6/14/2013
N8589
VARGHESE, TESSY ANN, MD
1/18/2011
P5754
11/4/2011
12/12/2008
3/1/2013
N7016
VARIA, APURV KIRIT, MD
VARKARAKIS, GEORGE MICHAEL,
MD
N7367
N9660
VARSHNEY, POOJA , MD
VARUGHESE, ROY , MD
8/2/2010
5/2/2011
N5452
P6103
N2863
VASALLO, JAVIER ALEJANDRO, MD
VASANTH, PAYASWINI , MD
VASEK, JAMES VENCIL JR, MD
2/5/2010
4/1/2013
4/3/2009
N5453
2/5/2010
N7368
VASQUES, DEETTE RAY, DO
VASQUEZ AGUILAR, MARIO LUIS,
MD
N6747
N1486
VASQUEZ, ISELA, MD
VASQUEZ, LENA ALLYSON, MD
P5310
VASSER, ELIZABETH, MD
P7592
VASUDEVAN, RAM RAJ, MD
VASUDEVAN, SANJEEV
AYYANGAR, MD
P0681
7/1/2010
8/2/2010
6/4/2010
10/10/2008
1/15/2013
8/1/2013
8/1/2011
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE
AUSTIN
CHILD AND
ADOLESCENT
Registration
Status of
Practice
Texas
State
License
ACTIVE
ACTIVE
LICENSE
ISSUED
IL
ACTIVE
2/13/2012 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
11/15/2011 None
1/7/2009 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
6/21/2013 None
N/A
1/18/2011 None
N/A
ACTIVE
3/18/2013 None
N/A
7/7/2010 None
N/A
TEMPLE
TX
GASTROENTEROLOG
Y
PLASTIC SURGERY
ALLERGY AND
IMMUNOLOGY
4/3/2014 RADIOLOGY
GYNECOLOGIC
2/5/2015 ONCOLOGY
NEUROLOGICAL
8/1/2018 SURGERY
DALLAS
TX
ACTIVE
AUSTIN
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
9/8/2010 None
5/12/2011 None
N/A
N/A
2/5/2010 None
4/5/2013 None
4/8/2009 None
N/A
N/A
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
9/1/2010 None
N/A
6/4/2010 None
10/20/2008 None
N/A
N/A
ACTIVE
1/29/2013 None
N/A
ACTIVE
8/9/2013 None
N/A
ACTIVE
8/5/2011 None
N/A
AUSTIN
TEMPLE
FAMILY MEDICINE
SPORTS MEDICINE
(FAMILY PRACTICE)
RIO GRANDE
CITY
TX
TX
TX
ROUND ROCK TX
8/1/2016 PEDIATRIC SURGERY GENERAL SURGERY HOUSTON
Page 279 of 300
N/A
N/A
ACTIVE
CRANIOFACIAL
7/1/2015 SURGERY
PEDIATRICS,
ALLERGY &
8/2/2015 IMMUNOLOGY
2/4/2011 None
6/7/2012 None
TX
PSYCHIATRY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/22/2013 None
N/A
7/8/2013 None
N/A
TX
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
N8070
Physician Name
VASYLYEVA, TETYANA
LEONIDIVNA, MD
N8590
VAUGHAN, JEREMY BRANDON, MD
1/18/2011
N6084
VAUGHN, CHARLES RAYMOND, DO
4/9/2010
N5455
VAYANI, RADHIKA , DO
2/5/2010
10/29/2010
N7596
VAYSBERG, MIKHAIL, DO
8/27/2010
N8868
VAYSMAN, DMITRIY , MD
2/15/2011
P2390
VAYUVEGULA, SATISH VENKATA,
MD
N7017
3/1/2012
4/9/2015 NEPHROLOGY
INTERNAL MEDICINE PECOS
OTOLARYN & FACIAL
PEDIATRIC
VASCULAR AND
INTERVENTIONAL
3/1/2017 RADIOLOGY
N8869
N8360
P6293
VEDAVALLI, ABHISHEK, MD
N7371
VEGA FERNANDEZ, PATRICIA , MD
8/2/2010
8/2/2015 PEDIATRICS
P3092
VEGESNA, VISWANADH RAJU, MD
5/1/2012
VEGI, SRIVALLI , MD
VEIGH, STEPHEN, DO
P2804
P7721
P2078
P6543
P0806
N7508
2/15/2011
12/15/2010
4/12/2013
VELA, JOSE VICTOR, MD
VELAGA, RAHUL, MD
VELAMURI, NARASIMHESWARA
SARMA, MD
VELASQUEZ, ALEX HERNAN, MD
4/2/2012
8/15/2013
2/1/2012
5/1/2013
VELASQUEZ, AUDEN C, MD
VELASQUEZ, GUSTAVO
GUILLERMO SR, MD
8/15/2011
8/16/2010
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/15/2010 None
N/A
2/5/2010 None
N/A
8/27/2010 None
N/A
2/15/2011 None
N/A
4/5/2012 None
N/A
7/1/2010 None
N/A
2/15/2011 None
12/24/2010 None
N/A
N/A
ORLAND PARK IL
DICKINSON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
CHICAGO
IL
ACTIVE
4/22/2013 None
N/A
ACTIVE
LICENSE
ISSUED
8/24/2010 None
N/A
5/1/2012 None
N/A
ACTIVE
ACTIVE
5/4/2009 None
11/22/2012 None
N/A
N/A
ACTIVE
ACTIVE
4/16/2012 None
8/30/2013 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/14/2012 None
5/6/2013 None
N/A
N/A
8/15/2011 None
N/A
8/16/2010 None
N/A
GERIATRIC
MEDICINE (INTERNAL
MED)
NEURO-RADIOLOGY NAPLES
FL
OCCUPATIONAL
MEDICINE
SAN ANTONIO TX
HOSPITALIST
MINNEAPOLIS MN
FAMILY PRACTICE
Page 280 of 300
10/29/2010 None
1/21/2011 None
SAN ANTONIO TX
4/3/2009
10/15/2012
Disciplinary
Status Date
ACTIVE
SLEEP MEDICINE
EMERGENCY
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
HEAD AND NECK
SURGERY
7/1/2015 PSYCHIATRY
PEDIATRIC EMER MED
2/15/2016 (PEDS)
PEDIATRICS
PULMONARY
CRITICAL CARE
EMERGENCY
8/16/2015 MEDICINE
Practice City
DALLAS
VAZQUEZ, JOSE JAVIER, MD
VAZQUEZ-CUFFE, ERIKA MARIE,
MD
VEASEY, GILBERT DEAN SR, MD
N2867
P4724
7/1/2010
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
PEDIATRIC
NEPHROLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
HOUSTON
HOUSTON
TX
TX
License
Number
Physician Name
N1488
VELAZQUEZ, JUAN PENA, MD
P3093
P1427
VELEY, GENE, MD
VELLANKI, VINITHA, MD
P1942
VELOSO, JOSE, MD
N5459
VEMURI, SRINATH SARMA, MD
P3476
P0149
VENKATARAMAN, ADITYA, MD
VENKATASUBBA RAO, CHETHAN
PADAVANAPALLI, MD
N7372
VERMA, AVESH RAJA, MD
N6751
P1502
VERMA, DIVYA RATAN , MD
VERMA, NAMITA, DO
P4524
N7373
N8255
VERMA, PRAGYA PREMKUMAR,
MD
VERNER-COLE, ELIZABETH ANNE,
MD
VERNON, KIMBERLY ANN, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
10/10/2008
PULMONARY
CRITICAL CARE
5/1/2012
5/1/2017 MEDICINE
11/4/2011
INTERNAL MEDICINE
EMERGENCY
1/17/2012
1/17/2017 MEDICINE
2/5/2010
6/1/2012
6/15/2016 NEUROLOGY
8/2/2010
8/2/2015 NEUROLOGY
8/2/2010
12/1/2010
P3477
P2805
N8591
VEST, ZACHARY , MD
VICK, KATIE M, MD
N7018
VICKERY, ROBERTA LUCILLE, MD
7/1/2010
P7593
VICTOR, DAVID W III, MD
VIDAL, AILEEN MICHELLE
DECIERDO, MD
8/1/2013
8/1/2018 HEPATOLOGY
P0682
6/4/2010
4/1/2011
6/4/2015 NEUROLOGY
4/1/2016 PEDIATRICS
6/1/2012
6/1/2017 NEUROLOGY
8/1/2011
ACTIVE
ACTIVE
AUSTIN
TX
CRITICAL CARE
ANESTHESIOLOGY
9/17/2012
4/2/2012
1/18/2011
TX
VA
CLINICAL
NEUROPHYSIOLOGY DALLAS
VERONA, MONTGOMERY ALAN,
MD
VERSHAW, ANNA , MD
VERTREES, STEPHANIE MICHAEL,
MD
K0232
N9324
COLLEGE
STATION
RICHMOND
6/15/2011
6/4/2010
11/15/2011
Registration
Status of
Practice
Texas
Practice City
State
License
SAN ANTONIO TX
ACTIVE
NEUROMUSCULAR
DISEASE
HOUSTON
TX
TX
HOSPITALIST
Page 281 of 300
5/21/2012 None
11/18/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
1/30/2012 None
N/A
2/5/2010 None
N/A
6/1/2012 None
N/A
6/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
DELINQUEN
T-NON
PAYMENT
8/20/2010 None
N/A
6/4/2010 None
11/18/2011 None
N/A
N/A
12/16/2012 None
N/A
8/16/2010 None
12/7/2010 None
N/A
N/A
6/4/2010 None
4/6/2011 None
N/A
N/A
6/8/2012 None
N/A
4/25/2012 None
1/25/2011 None
N/A
N/A
7/1/2010 None
N/A
8/1/2013 None
N/A
8/9/2011 None
N/A
HOUSTON
TX
EVANSVILLE
HOUSTON
IN
TX
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
AUSTIN
TX
ACTIVE
DALLAS
WACO
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
GASTROENTEROLOG
Y
CORPUS
CHRISTI
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
11/3/2008 None
N/A
ACTIVE
License
Number
Physician Name
P0886
VIDAVALUR, RAMESH, MD
N6087
VIJ, RAJIV S B, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/26/2011
4/9/2010
N5460
VIJAYAMADHAVAN, VIVEK KUMAR,
MD
VIJAYAN, SOUMIA , MD
VIJAYAPPA, MADHU
BUKKASAGARA, MD
P3478
VILLA, FILOMENA HAZEL , MD
6/1/2012
N9418
VILLAFRIA, RAMON GARCIA, MD
VILLALOBOS, JACKELINNE PILAR,
DO
VILLAROSA, MELANIO PASOS II,
MD
VILLA-ROYVAL, SILVIA MARIANA,
MD
VILLARREAL, BRIAN ALLEN, MD
4/8/2011
N8740
N8256
N5461
P0316
P6933
P3479
2/4/2011
12/1/2010
2/5/2010
2/5/2010
Secondary Specialty
(Self-Designated)
NEONATALNEONATALPERINATAL
8/26/2016 PERINATAL MEDICINE MEDICINE
4/9/2015 NEPHROLOGY
2/4/2016 PEDIATRICS
2/5/2015 NEUROLOGY
PEDIATRIC
6/1/2017 PEDIATRICS
5/2/2011
OBSTETRICS AND
5/2/2016 GYNECOLOGY
P4915
N8870
VINEY, REAGAN D'LYNN, MD
N6756
VIRK, ZIAULLAH , MD
N3376
VISINTINE, JOHN FRANCIS III, MD
5/29/2009
MATERNAL AND
N1943
P7366
VISWAM, GITA , MD
VITALE, KARLA SUE, DO
VIZCARRA-FALLA, LUIS RAFAEL,
MD
12/12/2008
7/15/2013
P2806
4/2/2012
TX
BROWNSVILL
E
TX
6/3/2013
6/1/2012
6/4/2010
DALLAS
SAN ANTONIO TX
7/1/2016 PEDIATRICS
2/15/2011
INTERNAL MEDICINE
NEONATALPERINATAL
MEDICINE
NEUROLOGY
7/1/2011
11/15/2012
CUMBERLAND MD
OBSTETRICS AND
2/5/2015 GYNECOLOGY
VILLAZANA-KRETZER, DIANA
LETICIA, DO
VILLEGAS, MELISSA CATHLEEN,
DO
N9661
Practice City
Registration
Status of
Practice
Texas
State
License
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
Page 282 of 300
N/A
4/9/2010 None
N/A
2/4/2011 None
12/6/2010 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/8/2012 None
N/A
4/8/2011 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
7/6/2011 None
N/A
6/3/2013 None
6/27/2012 None
N/A
N/A
5/9/2011 None
N/A
11/29/2012 None
N/A
2/15/2011 None
N/A
6/4/2010 None
N/A
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
SUGAR LAND
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
Disciplinary
Status Date
9/6/2011 None
SAN ANTONIO TX
INTERNAL MEDICINE
OBSTETRICS AND
CORPUS
GYNECOLOGY
CHRISTI
PUBLIC
HEALTH/PREVENTIVE
MEDICINE
(GENERAL)
PLANO
ANDREWS
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
6/22/2009 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
2/9/2009 None
7/22/2013 None
N/A
N/A
4/2/2012 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5903
VO, ANNE CHAU, DO
P5246
N9005
VO, KEVIN , MD
VON RITSCHL, ANDREAS JOHANN,
MD
P1429
VON RITSCHL, RUDIGER H, MD
P1430
N1947
VU, BRIAN DAT, MD
VU, KHANG NGUYEN, MD
P3597
VU, TIM , MD
N6759
P5490
P0807
VUELVAS, JUAN, MD
VUONG, CUONG TRI, MD
VUPPALI, KALPANA , MD
6/4/2010
2/1/2013
8/15/2011
N8741
N1211
VUU, THAI MINH, MD
VYAS, AMY M., MD
2/4/2011
8/29/2008
K9450
WACKER, NIKKI ULLRICH, MD
N4188
N7020
WADA, TAKAAKI , MD
WADE, RYAN SCOTT, DO
8/21/2009
7/1/2010
P5312
WADI, MUSA, MD
1/15/2013
H4770
N9991
WADLINGTON, VAN R, MD
WAGAR, ELIZABETH ANN, MD
3/1/2012
6/3/2011
3/1/2017 RADIOLOGY
6/3/2016 PATHOLOGY
P2392
WAGERS, STEVEN A JR, MD
3/1/2012
3/1/2017 RADIOLOGY
N9976
WAGLE, KAMAL CHANDRA, MD
6/3/2011
N7762
WAH, YU, MD
3/15/2013
1/4/2013
3/1/2011
3/1/2016 RADIOLOGY
11/4/2011
11/4/2011
12/12/2008
6/8/2012
8/1/2013
9/15/2010
Secondary Specialty
(Self-Designated)
PEDIATRIC
EMERGENCY
MEDICINE (EM)
NEURO-RADIOLOGY
11/4/2016 RADIOLOGY
EMERGENCY
11/4/2016 MEDICINE
EMERGENCY
6/8/2017 MEDICINE
LICENSE
ISSUED
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
4/13/2011 None
N/A
11/4/2011 None
N/A
8/30/2010
11/9/2011 None
1/1/2009 None
N/A
N/A
6/8/2012 None
N/A
6/4/2010 None
2/5/2013 None
8/18/2011 None
N/A
N/A
N/A
PLANO
CEDAR PARK
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
HOUSTON
HOUSTON
FLOWER
MOUND
TX
TX
ACTIVE
ACTIVE
2/10/2011 None
9/29/2008 None
N/A
N/A
TX
ACTIVE
8/6/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
9/22/2009 None
7/13/2010 None
N/A
N/A
1/15/2013 None
N/A
BIRMINGHAM
HOUSTON
AL
TX
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
ACTIVE
3/1/2012 None
6/10/2011 None
N/A
N/A
TACOMA
WA
3/5/2012 None
N/A
6/3/2011 None
N/A
10/18/2010 None
N/A
SLEEP MEDICINE
FRENCH
CAMP
Page 283 of 300
3/15/2013 None
SEE
PREVIOUS
1/9/2013 ORDER
ACTIVE
INTERNAL MEDICINE ABILENE
DALLAS
Disciplinary
Status Date
TX
HOUSTON
TX
SAN ANTONIO TX
INTERVENTIONAL
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
WYLIE
NEURO-RADIOLOGY
6/4/2015 PEDIATRICS
2/1/2018 RADIOLOGY
ORAL &
MAXILLOFACIAL
2/4/2016 SURGERY
8/1/2018 PEDIATRICS
INFECTIOUS
8/21/2014 DISEASES
PULMONARY
CRITICAL CARE
1/15/2018 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
CA
ACTIVE
LICENSE
ISSUED
ACTIVE
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
Practice City
P4725
WAHEED, MUSADDIQ, MD
10/15/2012
HOSPITALIST
P2079
WAHEED, UMAR, MD
2/1/2012
INTERNAL MEDICINE RENTON
WAKEHAM, CATHERINE
PHYSICAL MED. &
P6746
DAVENPORT POLLOCK, MD
5/15/2013
GERIATRICS
P1431
WAKIM, NADINE , MD
11/4/2011
DALLAS
WALCOTT, FARZANA LUKMANJI,
INTERNAL MED - PREV
N6760
MD
6/4/2010
6/4/2015 MED
PEDIATRIC
WALDROP, STEPHANIE WILLETTE,
EMERGENCY
P0514
MD
7/15/2011
MEDICINE (PEDS)
HOUSTON
N9978
P2393
P7367
WALES, ROBERT ALAN, MD
WALGAMA, ALISON LANE, MD
WALGAMA, EVAN SANATH, MD
P0317
1/17/2012
N6761
WALKER, CANDICE ESTELLE, MD
WALKER, TORRANCE ANTHONY,
MD
WALKIEWICZ, THOMAS WALTER,
MD
N4831
WALLACE, HENRY CASTON II, MD
11/6/2009
P2807
WALLACE, MARK KOWALSKI, MD
4/2/2012
P1945
P1432
P5011
WALLACE, PHILIP COLEMAN, MD
WALLACE, ROBIN, MD
P3094
WALN, OLGA , MD
N8361
6/3/2011
3/1/2012
7/15/2013
7/1/2011
6/4/2010
6/3/2016 CARDIOLOGY
OBSTETRICS AND
7/1/2016 GYNECOLOGY
ORTHOPEDIC
1/17/2017 SURGERY
6/4/2015 RADIOLOGY
ORTHOPEDIC
11/6/2014 SURGERY
ENDOCRINOLOGY,
DIABETES AND
4/2/2017 METABOLISM
11/4/2011
11/30/2012
11/4/2016
11/30/2017
5/1/2012
5/1/2017
WALPOLE, AARON JAMISON, MD
12/15/2010
12/15/2015
J9427
P5491
WALSH, RALPH CLAIBORNE JR,
DO
WALSTON, SHAYE LYSETTE, DO
1/18/2011
2/1/2013
1/18/2016
2/1/2018
P7722
WALTERS, JASON ANTHONY, MD
8/15/2013
8/15/2018
J0343
WALTHALL, ELLEN DELOY, MD
11/6/2009
11/6/2014
Registration
Status of
Practice
Texas
State
License
ACTIVE
WA
ACTIVE
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
WACO
DALLAS
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
AUSTIN
TX
ACTIVE
PINE BLUFF
AR
ACTIVE
LICENSE
ISSUED
TX
NEURORADIOLOGY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
10/22/2012 None
N/A
2/27/2012 None
N/A
5/28/2013 None
11/21/2011 None
N/A
N/A
6/4/2010 None
N/A
7/15/2011 None
N/A
6/3/2011 None
3/16/2012 None
7/31/2013 None
N/A
N/A
N/A
8/10/2011 None
N/A
2/2/2012 None
N/A
6/4/2010 None
N/A
TEMPLE
TX
ACTIVE
12/7/2009 None
N/A
NEW
BRAUNFELS
TX
ACTIVE
4/4/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
12/1/2011 None
12/19/2012 None
N/A
N/A
TX
ACTIVE
5/10/2012 None
N/A
VA
ACTIVE
1/21/2011 None
N/A
OH
ACTIVE
ACTIVE
1/26/2011 None
2/11/2013 None
N/A
N/A
TX
ACTIVE
8/16/2013 None
N/A
TX
ACTIVE
11/16/2009 None
N/A
PAIN
PHYSICAL MED. &
MANAGEMENT/REHA
REHABILITATION
B MED
AUSTIN
FAMILY MEDICINE
DALLAS
MOVEMENT
NEUROLOGY
DISORDERS
HOUSTON
EMERGENCY
FALLS
MEDICINE
CHURCH
FP/OSTEO
OSTEO MANIPULATIVE MANIPULATION
MEDICINE
MEDICINE
AKRON
PEDIATRICS
ORTHOPEDIC
SPORTS MEDICINE SURGERY
ORTHOPEDICS
MCKINNEY
SWEETWATE
GENERAL SURGERY
R
Page 284 of 300
License
Number
N8871
Physician Name
WALTON, GRACE JOY, MD
dicaid
dicaid
Agreement
End Date
Designated)
2/15/2011
WALZ, DANIELLE, MD
10/17/2011
N6762
WANDER, JASON FOX, DO
6/4/2010
EMERGENCY
3/1/2018 MEDICINE
EMERGENCY
11/6/2014 MEDICINE
9/1/2016 CARDIOLOGY
P5757
P1245
WANG, BO, MD
WANG, GORDON GUAN, MD
N4833
P0940
WANG, HAO, MD
WANG, HAOJIE , MD
11/6/2009
9/1/2011
N3382
WANG, JANET LUYU, MD
5/29/2009
N5469
WANG, JENNIFER , MD
2/5/2010
P6109
WANG, JOSHUA J, MD
4/1/2013
4/1/2018 PSYCHIATRY
P3679
N4192
WANG, LEI, MD
WANG, NORMAN C, MD
6/15/2012
8/21/2009
6/15/2017
8/21/2014 NEUROLOGY
N1216
WANG, SA , MD
8/29/2008
N6092
WANG, SEAN, MD
4/9/2010
P5247
WANG, VINCENT YAT-CHUNG, MD
1/4/2013
8/29/2013 PATHOLOGY
EMERGENCY
4/9/2015 MEDICINE
NEUROLOGICAL
1/4/2018 SURGERY
P7868
WANG, WEI, MD
8/30/2013
P2558
WANG, WEIZHENG WILLIAM, MD
3/15/2012
P1831
WANTHAKAWIKRAN, CHALIT , MD
1/2/2012
P1946
WARACH, STEVEN JAY, MD
1/17/2012
N9145
WARD, JENAYA JUDONNE, MD
3/15/2011
P2808
WARE, RUSSELL EARL, MD
4/2/2012
Practice City
P1244
3/1/2013
10/17/2011
Secondary Specialty
(Self-Designated)
URGENT CARE
MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
N/A
ACTIVE
LICENSE
ISSUED
10/25/2011 None
N/A
6/4/2010 None
N/A
TX
TX
ACTIVE
ACTIVE
3/5/2013 None
11/11/2011 None
N/A
N/A
TX
ACTIVE
ACTIVE
11/11/2009 None
12/1/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
6/15/2009 None
N/A
2/5/2010 None
N/A
4/8/2013 None
N/A
6/15/2012 None
9/14/2009 None
N/A
N/A
SPORTS MEDICINE
HEMATOLOGY/ONCO
LOGY
HEMATOLOGY/ONCO
LOGY
CHILD AND
ADOLESCENT
PSYCHIATRY
DALLAS
HEMATOLOGY
(PATHOLOGY)
8/30/2018 INTERNAL MEDICINE FAMILY MEDICINE
GASTROENTEROLOG
3/15/2017 Y
HEPATOLOGY
1/2/2017 NEPHROLOGY
VASCULAR
NEUROLOGY
1/17/2017 NEUROLOGY
OBSTETRICS AND
PEDIATRIC
HEMATOLOGY/ONCOL
4/2/2017 OGY
Page 285 of 300
Disciplinary
Status Date
2/15/2011 None
SAN ANTONIO TX
HOUSTON
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
PHOENIX
AZ
ACTIVE
LICENSE
ISSUED
ACTIVE
HOUSTON
TX
ACTIVE
9/18/2008 None
N/A
SAN ANTONIO TX
ACTIVE
4/26/2010 None
N/A
SUGAR LAND
LAKE
CHARLES
TX
ACTIVE
1/22/2013 None
N/A
LA
ACTIVE
LICENSE
ISSUED
9/6/2013 None
N/A
3/15/2012 None
N/A
HOUSTON
TX
ACTIVE
1/16/2012 None
N/A
AUSTIN
TX
ACTIVE
1/23/2012 None
N/A
DALLAS
TX
ACTIVE
3/21/2011 None
N/A
HOUSTON
TX
ACTIVE
4/12/2012 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
P7047
Physician Name
WARMINSKI, JOHNATHAN DAVID,
MD
WARRAICH, KHAWAR NADEEM,
MD
N4837
P0318
WARREN, JAMES KEITH , MD
WARREN, RANDALL JAMES, MD
11/6/2009
7/1/2011
P2080
WARREN, WARD RANDALL, MD
2/1/2012
N2336
WARUINGI, WAMBUI , MD
2/6/2009
N4836
P3266
Secondary Specialty
(Self-Designated)
Practice City
11/6/2009
OPHTHALMOLOGY
6/14/2013
CARDIOVASCULAR
11/6/2014 DISEASES
EMERGENCY
2/1/2017 MEDICINE
INTERNAL MEDICINE WATERLOO
INTERNAL MEDICINE KYLE
TAMPA
N/A
IA
ACTIVE
7/9/2013 None
N/A
TX
FL
ACTIVE
ACTIVE
11/18/2009 None
7/8/2011 None
N/A
N/A
ACTIVE
2/20/2012 None
N/A
ACTIVE
12/16/2009 None
N/A
TX
ACTIVE
5/18/2012 None
N/A
CYTOPATHOLOGY
TYLER
TX
ACTIVE
LICENSE
ISSUED
4/30/2010 None
N/A
8/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
6/14/2011 None
N/A
10/15/2012 None
N/A
12/17/2012 None
1/22/2013 None
1/22/2013 None
N/A
N/A
N/A
8/9/2011 None
N/A
10/29/2010 None
N/A
6/4/2010 None
N/A
8/30/2013 None
N/A
P7723
WASHINGTON, GINA PATRICE, MD
8/15/2013
N9982
WATT, TANYA CARENS, MD
P4726
WATTANA, MONICA , MD
10/15/2012
PEDIATRIC
HEMATOLOGY/ONCOL
6/3/2016 OGY
PEDIATRICS
EMERGENCY
10/15/2017 MEDICINE
P5145
P5145
P5145
WATTS, JAMES , MD
WATTS, JAMES , MD
WATTS, JAMES , MD
12/17/2012
12/17/2012
12/17/2012
P0515
WATTS, TAMMARA LYNN, MD
7/15/2011
G0269
WAUGH, DENISE GAYLE, MD
10/29/2010
N6763
WAW, KRISTEN DEANN, MD
P7869
WEBB, ANTHONY, MD
P2396
WEBER, IAN CHARLES, MD
P1709
WEBER, MICHAEL ANDREW, MD
6/4/2015 PEDIATRICS
8/30/2013
3/1/2012
EMERGENCY
12/15/2016 MEDICINE
DALLAS
TX
OTOLARYN & FACIAL
PLASTIC SURGERY
GALVESTON
EMERGENCY
10/29/2015 PALLIATIVE MEDICINE MEDICINE
6/4/2010
12/15/2011
11/16/2009 None
DALLAS
N6093
Disciplinary
Status Date
TRANSPLANT
SURGERY
5/15/2012
6/3/2011
ANATOMIC/CLINICAL
4/9/2015 PATHOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
WASHER, JOSHUA DANIEL, MD
WASHINGTON, ANTOINE PHASHA,
MD
4/9/2010
Registration
Status of
Practice
Texas
State
License
TEMPLE
INTERNAL MEDICINE
ORTHOPEDIC
TRAUMA
OMAHA
TYLER
Page 286 of 300
TX
TX
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
NE
ACTIVE
3/23/2012 None
N/A
TX
ACTIVE
12/26/2011 None
N/A
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
WEBER-LASHORE, AKILAH FAIZAH,
OBSTETRICS AND
N7024
MD
7/1/2010
7/1/2015 GYNECOLOGY
OTHER SPECIALTY
EMERGENCY
N7892
WEDDEL, PAULA, MD
10/1/2010
10/1/2015 MEDICINE
HEMATOLOGY P6296
WEHBE, AHMAD MOUHAMAD, MD
4/12/2013
4/12/2018 ONCOLOGY
INTERNAL MEDICINE
P1710
WEHBE, EDGARD IBRAHIM, MD
12/15/2011
N7663
WEINBERG, BRENT DEREK, MD
9/1/2010
P2809
WEINER, DREW SCOTT, MD
4/2/2012
N4197
N7509
WEINTRAUB, BERNARD MAURICE,
MD
WEISBERG, MARK JORDAN, MD
WEISMAN, HENRY W JONATHAN,
MD
WEISS, CAREY IRA, MD
P2171
P7227
WEIST, DAVID JOHN, MD
WELCH, BRANDY NICOLE, MD
2/10/2012
7/1/2013
P0152
P1834
WELCH, SHARI JULE, MD
WELDON, CHAD EDWARD, DO
6/15/2011
1/2/2012
P1711
WELLER, AMANDA LINDSLEY, MD
P5012
P1947
11/30/2012
1/17/2012
8/21/2009
8/16/2010
12/15/2011
INTERNAL MEDICINE NEWTON
EMERGENCY
2/10/2017 MEDICINE
7/1/2018 PEDIATRICS
EMERGENCY
6/15/2016 MEDICINE
ORTHOPEDIC
12/15/2016 SURGERY
8/15/2011
6/14/2013
6/14/2018 RADIOLOGY
N4198
WELLS, JENNIFER TATUM , MD
WENNER, MELINDA ELIZABETH,
DO
8/21/2009
8/21/2014 HEPATOLOGY
WENZEL, MARC EVAN, MD
WEPRICH, DEVON JOY, DO
WERAGODA, RAMAL MAJINTHA,
MD
8/1/2011
12/15/2011
J1426
P1712
N7026
7/1/2010
PSYCHOSOMATIC
MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
Disciplinary
Status Date
ACTIVE
7/7/2010 None
N/A
TX
ACTIVE
10/6/2010 None
N/A
ACTIVE
LICENSE
ISSUED
4/17/2013 None
N/A
12/15/2011 None
N/A
9/22/2010 None
N/A
DALLAS
TX
ACTIVE
DALLAS
TX
ACTIVE
NJ
ACTIVE
ACTIVE
EL PASO
FT. WORTH
TX
TX
ACTIVE
ACTIVE
8/31/2009 None
8/19/2010 None
N/A
N/A
KERRVILLE
MCKINNEY
SALT LAKE
CITY
TYLER
TX
TX
ACTIVE
ACTIVE
2/16/2012 None
7/2/2013 None
N/A
N/A
UT
TX
ACTIVE
ACTIVE
6/20/2011 None
1/31/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
12/19/2011 None
N/A
SHREVEPORT LA
CARLSBAD
NM
ACTIVE
ACTIVE
8/18/2011 None
6/25/2013 None
N/A
N/A
ACTIVE
8/25/2009 None
N/A
ACTIVE
1/5/2012 None
N/A
ACTIVE
ACTIVE
8/8/2011 None
1/3/2012 None
N/A
N/A
ACTIVE
7/14/2010 None
N/A
GASTROENTEROLOG
Y
DALLAS
TX
1/2/2017 PEDIATRICS
ENDOCRINOLOGY,
DIABETES AND
8/1/2016 METABOLISM
Page 287 of 300
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
SAN ANTONIO TX
INTERNAL MEDICINE
WELLIKOFF, ADAM S, MD
WELLS, DAVID LAWRENCE, MD
1/2/2012
DALLAS
SULPHUR
SPRINGS
DIAGNOSTIC
9/1/2015 RADIOLOGY
EMERGENCY
4/2/2017 MEDICINE
P0808
P7048
P1835
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
4/5/2012 None
UNDER
BOARD
12/10/2012 ORDER
1/24/2012 None
N/A
11/30/2012
N/A
License
Number
Physician Name
N7027
WESLEY, ROBBY GEORGE, DO
dicaid
dicaid
Agreement
End Date
Designated)
7/1/2010
P1031
WEST, CHARLES ADGER JR, MD
P7594
WEST, DEREK LAMONT, MD
8/1/2013
N6096
WESTFALL, AMANDA, MD
4/9/2010
P3098
5/1/2012
P5577
WESTOVER, KENNETH, MD
WETHERILL, TIMOTHY
FARRINGTON, MD
N9793
WHEELER, PAUL D, MD
N2882
P1247
WHITAKER, DUANE COLE, MD
WHITE, GREGORY RYAN, MD
P2932
WHITE, JEFFERY, MD
4/13/2012
N8873
WHITE, MICHAEL ANTHONY, DO
2/15/2011
P2810
WHITE, MICHAEL JOSEPH, MD
4/2/2012
N7028
WHITE, NOAH COOPER, MD
7/1/2010
P1504
WHITLEY, DOUGLAS ELLIOTT, MD
N4201
WHITMAN, BRUCE STEVEN, DO
N7029
N8157
P2399
WHITMAN, CHRISTINE MINAH, MD
WHITMAN, ERIC JASON, MD
WHITNEY, ERIN AHRENS, MD
P6936
WHITTY, JANICE ELIZABETH, MD
6/3/2013
P1837
WHU, MAYBELLE STAEHELI, MD
1/2/2012
TM00523 WICHMAN, HEATHER JO, MD
9/15/2011
2/8/2013
5/16/2011
4/3/2009
10/17/2011
11/15/2011
8/21/2009
7/1/2010
11/15/2010
3/1/2012
9/17/2012
GENERAL VASCULAR
9/15/2016 SURGERY
INTERVENTIONAL
8/1/2018 RADIOLOGY
EMERGENCY
4/9/2015 MEDICINE
RADIATION
5/1/2017 ONCOLOGY
DIAGNOSTIC
5/16/2016 RADIOLOGY
DERMATOLOGIC
4/3/2014 SURGERY
VASCULAR AND
INTERVENTIONAL
4/13/2017 RADIOLOGY
Secondary Specialty
(Self-Designated)
TX
ACTIVE
HOUSTON
TX
DALLAS
9/17/2017 RADIOLOGY
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/14/2010 None
N/A
11/14/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/16/2013 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
5/7/2012 None
N/A
2/8/2013 None
N/A
NEURO-RADIOLOGY
SHERMAN
TX
ACTIVE
6/20/2011 None
N/A
DERMATOLOGY
PASADENA
GALVESTON
TX
TX
ACTIVE
ACTIVE
4/21/2009 None
11/14/2011 None
N/A
N/A
WACO
TX
ACTIVE
LICENSE
ISSUED
4/17/2012 None
N/A
2/15/2011 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
11/18/2009 None
N/A
FORT HOOD
FORT HOOD
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
7/1/2010 None
1/12/2011 None
3/26/2012 None
N/A
N/A
N/A
6/3/2013 None
N/A
DIAGNOSTIC
RADIOLOGY
2/15/2016 PEDIATRIC UROLOGY
EMERGENCY
4/2/2017 MEDICINE
EMERGENCY
7/1/2015 MEDICINE
EMERGENCY
11/15/2016 MEDICINE
EMERGENCY
8/21/2014 MEDICINE
7/1/2015 PEDIATRICS
11/15/2015 UROLOGY
OBSTETRICS AND
6/3/2018 GYNECOLOGY
EMERGENCY
1/2/2017 MEDICINE
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
MATERNAL AND
FETAL MEDICINE
FAMILY MEDICINE
INTERVENTIONAL
RADIOLOGY
Page 288 of 300
LAREDO
TX
ACTIVE
1/5/2012 None
N/A
MILWAUKEE
WI
ACTIVE
12/7/2012 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
N7031
Physician Name
WICKHAM, LAWRENCE KENNETH,
MD
WICKRAMASINGHE, ASHTON
SENATHI, MD
P7870
WIESE, STEVEN MICHAEL, MD
N9983
WIESNER, JASON BILLINGS, MD
P1505
WIGGINS, JOSHUA THOMAS, MD
P4528
WILBURN-WREN, KRISTIE RENEE,
MD
9/17/2012
P3485
N4202
WILCOX, DARRELL WALLACE, MD
WILEY, CHERESE MARIE, MD
6/1/2012
8/21/2009
F7962
4/1/2013
7/1/2010
8/30/2013
6/3/2011
11/15/2011
P0320
WILKE, LESLIE DAWN, DO
K4295
WILKINSON, EVERETT JAMES JR,
DO
5/16/2011
P5905
P5906
WILKOFSKY, IAN GEOFF, MD
WILLERS, GARY PAUL II, DO
3/15/2013
3/15/2013
P2082
WILLIAM, WILLIAM NASSIB JR, MD
N4203
WILLIAMS, ANNETTE LYNN , MD
N7763
7/1/2011
2/1/2012
8/21/2009
Secondary Specialty
(Self-Designated)
PEDIATRICS
EMERGENCY
8/30/2018 MEDICINE
DIAGNOSTIC
6/3/2016 RADIOLOGY
ORTHOPEDIC
5/16/2016 SURGERY
ORTHOPEDIC
3/15/2018 SURGERY
2/1/2017 ONCOLOGY
EMERGENCY
8/21/2014 MEDICINE
9/15/2010
9/15/2015
N9663
WILLIAMS, BRIAN HENRY, MD
WILLIAMS, CHRISTOPHER
GEORGE, MD
5/2/2011
5/2/2016
P2083
P0321
WILLIAMS, DANNIE ERICA, MD
WILLIAMS, DEREK EDWIN, MD
2/1/2012
7/1/2011
2/1/2017
7/1/2016
N9420
WILLIAMS, DUSTIN BLAKE, MD
4/8/2011
4/8/2016
N7032
WILLIAMS, FAYETTE CREED, MD
7/1/2010
7/1/2015
PULMONARY
CRITICAL CARE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
Practice City
NEWPORT
BEACH
CA
ACTIVE
4/5/2013 None
N/A
REDMOND
OR
ACTIVE
7/14/2010 None
N/A
9/4/2013 None
N/A
6/3/2011 None
N/A
11/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
OBSTETRICS &
GYNECOLOGICAL
9/17/2017 SURGERY
Registration
Status of
Practice
Texas
State
License
DALLAS
TX
ACTIVE
10/1/2012 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
6/7/2012 None
9/21/2009 None
N/A
N/A
TEMPLE
TX
ACTIVE
TEXAS
LICENSE
ISSUED
7/7/2011 None
N/A
5/16/2011 None
N/A
BAYTOWN
TX
ACTIVE
ACTIVE
3/19/2013 None
3/19/2013 None
N/A
N/A
TX
ACTIVE
2/7/2012 None
N/A
SAN ANTONIO TX
ACTIVE
9/8/2009 None
N/A
DALLAS
TX
ACTIVE
9/20/2010 None
N/A
5/16/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/1/2012 None
7/29/2011 None
N/A
N/A
ACTIVE
4/18/2011 None
N/A
7/1/2010 None
N/A
OBSTETRICS
CRITICAL CARE
TRAUMATIC SURGERY (TRAUMA)
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
GENERAL SURGERY
EMERGENCY
MEDICINE
ORAL &
MAXILLOFACIAL
SURGERY
Page 289 of 300
DALLAS
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P3680
WILLIAMS, FELICIA NICOLE, MD
P1249
WILLIAMS, GETHIN, MD
P0517
WILLIAMS, JAMES STUART, MD
7/15/2011
N7033
WILLIAMS, JENNIFER LYNN, MD
7/1/2010
WILLIAMS, NAZANIN, MD
WILLIAMS, RICHARD MALCOLM,
TM00496 MD
2/5/2010
N5484
6/15/2012
10/17/2011
12/15/2011
7/1/2015 RADIOLOGY
EMERGENCY
2/5/2015 MEDICINE
DIAGNOSTIC
WILLIAMS, TERESA RENEE, MD
6/3/2011
N7664
WILLIAMS, WENDIE RENEE, MD
9/1/2010
N3389
WILLIAMSON, JOHN ANDREW, MD
P3486
WILLIS, DANIEL LEVI, MD
N9146
WILLIS, JASON SCOTT, MD
P6551
P0810
WILLIS, THOMAS JOSEPH, MD
WILSON, ANWAR COLLINWOOD,
MD
8/15/2011
P3268
WILSON, GABRIEL ROLAND, MD
5/15/2012
N8874
P0518
2/15/2011
7/15/2011
N6771
WILSON, JAMES, MD
WILSON, JUSTIN WESLEY, MD
WILSON-OKAFOR, BRIDGET DEAN,
MD
EMERGENCY
8/15/2016 MEDICINE
EMERGENCY
5/15/2017 MEDICINE
EMERGENCY
2/15/2016 MEDICINE
6/4/2010
N9331
WILTZ, AIMEE LORELEI, MD
4/1/2011
4/1/2016 UROLOGY
N5485
WIN, OHMAR, MD
6/1/2012
3/15/2011
5/1/2013
2/5/2010
EMERGENCY
9/1/2015 MEDICINE
VASCULAR AND
INTERVENTIONAL
5/29/2014 RADIOLOGY
6/1/2017 UROLOGY
3/15/2016 PATHOLOGY
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/29/2012 None
N/A
10/17/2011 None
N/A
TX
ACTIVE
7/26/2011 None
N/A
MA
ACTIVE
LICENSE
ISSUED
7/13/2010 None
N/A
2/5/2010 None
N/A
ACTIVE
LICENSE
ISSUED
1/3/2012 None
N/A
6/3/2011 None
N/A
SCOTTSDALE AZ
N9984
5/29/2009
Secondary Specialty
(Self-Designated)
Practice City
SURGICAL CRITICAL
CARE
GALVESTON
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
EMERGENCY
MEDICINE
BIG LAKE
PEDIATRIC
RADIOLOGY
BOSTON
Registration
Status of
Practice
Texas
State
License
GERIATRICS
PLANO
TX
ACTIVE
10/4/2010 None
N/A
DIAGNOSTIC
RADIOLOGY
AUSTIN
TX
ACTIVE
6/10/2009 None
N/A
TX
ACTIVE
6/8/2012 None
N/A
TX
ACTIVE
3/29/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
5/7/2013 None
N/A
8/15/2011 None
N/A
5/21/2012 None
N/A
2/15/2011 None
8/2/2011 None
N/A
N/A
6/4/2010 None
N/A
4/1/2011 None
N/A
2/5/2010 None
N/A
HEMATOLOGY
(PATHOLOGY)
DALLAS
CORPUS
CHRISTI
SAN ANTONIO TX
ANESTHESIOLOGY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Page 290 of 300
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
H0953
N8158
P5314
WINDSOR, ROBERT E JR, MD
WINEGEART, GARIN TODD, DO
WINFORD, JUNE KRISTIN, MD
P7369
WINN, WILLIAM BYRON, DO
dicaid
dicaid
Agreement
End Date
Designated)
8/26/2011
11/15/2010
1/15/2013
8/26/2016
11/15/2015
1/15/2018
7/15/2013
7/15/2018
5/16/2011
PHYSICAL MED. &
REHABILITATION
FAMILY MEDICINE
RADIOLOGY
PHYSICAL MED. &
REHABILITATION
N9795
WINSTON, NICOLE, MD
P7228
WINTER, LANCE RICHARD, DO
7/1/2013
5/16/2016 NEUROLOGY
ORTHOPEDIC
7/1/2018 SURGERY
N6102
WINTERMEYER, KEITH A, MD
4/9/2010
4/9/2015 PEDIATRICS
P0519
P3100
P1153
WIRASZKA, TOMASZ ADAM, MD
WIRTH, JOHNNY JAMES, MD
WISZNIEWSKI, WOJCIECH
KRZYSZTOF, MD
N6104
WITTLER, MICAH, DO
PAIN MANAGEMENT
BREAST IMAGING
NEUROMUSCULAR
DISEASE
MCKINNEY
7/15/2011
5/1/2012
10/3/2011
10/17/2011
10/3/2016 MEDICAL GENETICS
EMERGENCY
4/9/2015 MEDICINE
ORTHOPEDIC
10/17/2016 SURGERY
8/30/2013
7/15/2010
PEDIATRIC
HEMATOLOGY/ONCOL
10/10/2013 OGY
RADIATION
9/1/2016 ONCOLOGY
EMERGENCY
6/4/2015 MEDICINE
4/9/2010
P1251
WOICZIK, MARCELLA RAE, MD
P7871
N7190
WOLDEYES, LIBAY, MD
WOLF, MATTHIAS TILMANN
FLORIAN, MD
N1495
WOLFF, JOHANNES ERNST
ALEXANDER, MD
P0942
WOLSKI, MICHAL JACEK, MD
9/1/2011
N6774
WONG, DAVID CHUNWAN, MD
6/4/2010
10/10/2008
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
Practice City
State
License
TEXAS
LICENSE
MARIETTA
GA
ISSUED
FORT WORTH TX
ACTIVE
ACTIVE
LICENSE
ISSUED
N9149
WONG, HOWARD LELAND, MD
3/15/2011
N2888
WONG, ROBERT WILLIAM , MD
4/3/2009
P5497
WOO, JUAN ANTONIO, MD
2/1/2013
TX
OPHTHALMOLOGY RECONST SURGERY
TX
PEDIATRIC
ORTHOPEDICS
HOSPITALIST
PEDIATRIC
NEPHROLOGY
PEDIATRIC
PSYCHIATRY
OPHTHALMOLOGY
Page 291 of 300
Disciplinary
Status Date
8/26/2011 None
11/19/2010 None
2/14/2013 None
N/A
N/A
N/A
7/15/2013 None
N/A
ACTIVE
5/24/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/14/2013 None
N/A
4/9/2010 None
N/A
7/15/2011 None
5/3/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
11/1/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
LICENSE
ISSUED
11/22/2011 None
N/A
8/30/2013 None
N/A
LICENSE
ISSUED
ACTIVE
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
ACTIVE
7/27/2010 None
N/A
HOUSTON
TX
ACTIVE
10/22/2008 None
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
9/7/2011 None
N/A
6/4/2010 None
N/A
GALVESTON
TX
ACTIVE
3/30/2011 None
N/A
AUSTIN
TX
ACTIVE
4/9/2009 None
N/A
ACTIVE
2/19/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
RADIATION
3/1/2011
3/1/2016 ONCOLOGY
10/10/2008
5/29/2009
EMERGENCY
5/29/2009
5/29/2014 MEDICINE
N9011
N1496
N3390
WOO, VAN HOY, MD
WOOD, ADAM SCOTT, MD
WOOD, FRANCES OLIVER, MD
N3391
WOOD, IRA BICKHAM III, MD
P4835
WOOD, JAMES HUNTER, MD
11/1/2012
N5489
P3269
WOOD, JASON , MD
WOODALL, BRUCE DALE, MD
WOOD-HORRALL, REBECCA
NAOMI, MD
2/5/2010
5/15/2012
P6553
N6107
5/1/2013
4/9/2010
EMERGENCY
2/5/2015 MEDICINE
EMERGENCY
5/1/2018 MEDICINE
P4918
WOODS, RASHIDA HALIMA, MD
WOODWARD PU, YEE-MING
PANDORA, MD
N9332
WOODWARD, LEE M, MD
4/1/2011
N1960
WOOLARD, ROBERT , MD
12/12/2008
P6937
WOOLDRIDGE, RACHEL DIANE, MD
N4849
WOOTEN, ERIC T., DO
11/6/2009
N7037
N3393
WORKMAN, JAMES LEONARD JR,
MD
WORLEY, TODD ANTHONY , MD
7/1/2010
5/29/2009
P1437
WRIGHT, COY ALLEN, MD
11/4/2011
7/1/2015 RADIOLOGY
ORTHOPEDIC
11/4/2016 SURGERY
N8257
WRIGHT, EDWARD DAVID, MD
12/1/2010
P0684
WRIGHT, JESSICA, MD
8/1/2011
N5490
2/5/2010
P4836
WRIGHT, JUSTIN MICHAEL, MD
WRIGHT, ROSEMARY ELIZABETH,
DO
11/1/2012
N1230
WRIGHT, TRACEY , MD
8/29/2008
11/15/2012
6/3/2013
4/9/2015 PEDIATRICS
EMERGENCY
11/15/2017 MEDICINE
PEDIATRIC
EMERGENCY
12/12/2013 MEDICINE
SURGICAL BREAST
6/3/2018 ONCOLOGY
EMERGENCY
8/1/2016 MEDICINE
SPORTS 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
TULSA
TEMPLE
DALLAS
OK
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/6/2011 None
12/11/2008 None
6/8/2009 None
N/A
N/A
N/A
AUSTIN
TX
ACTIVE
6/17/2009 None
N/A
PEDIATRIC SURGERY DALLAS
TX
11/2/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/5/2010 None
6/4/2012 None
N/A
N/A
ATHENS
CORPUS
CHRISTI
TX
ACTIVE
5/7/2013 None
N/A
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
TX
ACTIVE
4/15/2010 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
1/7/2013 None
N/A
4/1/2011 None
N/A
INTERNAL MEDICINE
SURGICAL
ONCOLOGY
TRAUMATIC
SURGERY
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
EL PASO
TX
ACTIVE
1/14/2009 None
N/A
DALLAS
TX
ACTIVE
6/10/2013 None
N/A
BEAUMONT
TX
ACTIVE
12/9/2009 None
N/A
MAUMELLE
HOUSTON
AR
TX
ACTIVE
ACTIVE
7/13/2010 None
6/8/2009 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
11/11/2011 None
N/A
12/1/2010 None
N/A
ACTIVE
LICENSE
ISSUED
8/5/2011 None
N/A
2/5/2010 None
N/A
DERMATOPATHOLO
GY
PEDIATRIC
Page 292 of 300
DALLAS
TX
ACTIVE
1/8/2013 None
N/A
DALLAS
TX
ACTIVE
9/26/2008 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
N3394
N5516
P6113
Physician Name
WRIGHT-BOWERS, DEBRA
SHANELLE, MD
WU, CHUANG-KUO, MD
WU, DANIEL , MD
P2174
P6554
P6555
WU, FRANCIS MIEN LI, MD
WU, JENNIFER QI, MD
WU, JONATHAN, MD
2/10/2012
5/1/2013
5/1/2013
N5491
WU, JUSTINA CHIA-SU , MD
2/5/2010
5/29/2009
4/9/2010
4/1/2013
4/9/2015 NEUROLOGY
DIAGNOSTIC
2/10/2017 RADIOLOGY
WU, KENNETH QIAN, MD
6/14/2013
P7727
P5762
WU, LAURA JUICHEN, MD
WU, MONICA ADWOAFUAA, MD
8/15/2013
3/1/2013
N5492
WU, STANLEY , MD
N4853
WU, THEODORE, MD
8/15/2018 NEUROLOGY
EMERGENCY
2/5/2015 MEDICINE
PEDIATRIC CRITICAL
N8472
WYCKOFF, SHAMOLIE NICOLE, MD
1/3/2011
P6556
WYCOFF, ROBERT MARC, MD
5/1/2013
N9336
WYKOFF, CHARLES CLIFTON, MD
4/1/2011
P6938
WYRICK, SARA, MD
6/3/2013
PEDIATRIC
EMERGENCY
P7052
WYSOCKI, CHRISTIAN ALLEN, MD
6/14/2013
P1948
P2086
XIA, YANG, MD
XIE, BINGRU, MD
1/17/2012
2/1/2012
2/1/2017 HEPATOLOGY
N5493
XIE, CHUN , MD
P7371
P1033
XINTAVELONIS, ELENA , MD
XU, RISHENG , DO
11/6/2009
2/5/2010
7/15/2013
9/15/2011
Practice City
WAXAHACHIE TX
LUBBOCK
TX
TEMPLE
TX
EMERGENCY
5/1/2018 MEDICINE
Disciplinary
Status Date
7/13/2009 None
4/28/2010 None
4/8/2013 None
N/A
N/A
N/A
2/10/2012 None
5/6/2013 None
5/6/2013 None
N/A
N/A
N/A
2/5/2010 None
N/A
ACTIVE
6/18/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/20/2013 None
3/22/2013 None
N/A
N/A
2/5/2010 None
N/A
ACTIVE
1/7/2010 None
N/A
ACTIVE
2/1/2011 None
N/A
TX
ACTIVE
5/29/2013 None
N/A
TX
ACTIVE
4/6/2011 None
N/A
PEDIATRICS
AUSTIN
ALLERGY AND
IMMUNOLOGY
DALLAS
DERMATOLOGIC
SURGERY
TX
6/10/2013 None
N/A
6/14/2013 None
N/A
1/17/2012 None
2/13/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/5/2010 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
8/5/2013 None
10/3/2011 None
N/A
N/A
CEDAR PARK TX
FORT WORTH TX
MOVEMENT
DISORDERS
TYLER
TX
HOUSTON
TX
PEDIATRICS
SAN ANTONIO TX
PAIN
MANAGEMENT/REHA
B MED
PLANTATION FL
AUSTIN
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
2/5/2015 CARDIOLOGY
P7051
2/5/2010
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
TX
INTERNAL MED PREV MED
Page 293 of 300
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5248
P6300
P6115
P4531
YACOB, GABRIEL E, MD
YACTOR, AMY REBECCA, MD
YAFT, JOHN WAGDY, MD
YAGHMAIE, MEHRAN, MD
P3488
6/1/2012
1/18/2011
P6751
YAKER, KENNETH MARCUS, MD
YALAMANCHI, LAKSHMANA RAO,
MD
YALAMANCHILI, BINDU BHARGAVI,
MD
P5014
YALAMANCHILI, KIRAN KUMAR, MD
11/30/2012
N2889
P0154
YALLAMPALLI, SASIDHAR , MD
YAMANI, HUSSEIN NOORUDDIN,
MD
N7766
P4919
P1439
P4532
P1838
YAMOAH, EDWARD HAMMOND, MD
YAN, JINGYIN , MD
YANDRAPU, HARATHI, MD
YANES, JESUS AGUIRRE III, MD
YANG, BYUNGWOO, MD
P0685
YANG, CAROLINE , MD
N8746
N8598
P4729
YANG, DIANA PEGGY, MD
YANG, HUA, MD
YANG, JENNIFER MARIE JUINIO,
MD
N9664
YAO, YUMEI, MD
N7980
N8473
N2890
P7872
YAQOOB, FEROZ, MD
YARAMADA, HEMALATHA, MD
YARBROUGH, SHANNON , MD
YARBROUGH, TRACY LYNNETTE,
MD
N7191
YARIMA, WAKILI SALIHU, MD
N8597
1/4/2013
4/12/2013
4/1/2013
9/17/2012
5/15/2013
4/3/2009
6/15/2011
9/15/2010
11/15/2012
11/4/2011
9/17/2012
1/2/2012
8/1/2011
2/4/2011
1/18/2011
1/4/2018
4/12/2018
4/1/2018
9/17/2017
ANESTHESIOLOGY
RADIOLOGY
INTERNAL MEDICINE
INTERNAL MEDICINE
HOSPITALIST
9/15/2015
11/15/2017
11/4/2016
9/17/2017
1/2/2017
ANESTHESIOLOGY
NEPHROLOGY
HOSPITALIST
FAMILY MEDICINE
FAMILY MEDICINE
8/1/2016 RADIOLOGY
10/15/2012
5/2/2011
10/15/2010
1/3/2011
4/3/2009
8/30/2013
EMERGENCY
7/15/2015 MEDICINE
Practice City
DALLAS
DALLAS
GENERAL PRACTICE IRVING
TX
HEMATOLOGY/ONCOL
11/30/2017 OGY
DIAGNOSTIC
4/3/2014 RADIOLOGY
INTERVENTIONAL
CARDIOLOGY
PHYSICAL MED. &
7/15/2010
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
ACTIVE
1/4/2013
4/16/2013
4/11/2013
9/18/2012
Disciplinary
Status Date
None
None
None
None
N/A
N/A
N/A
N/A
6/15/2012 None
N/A
ACTIVE
LICENSE
ISSUED
2/7/2011 None
N/A
5/15/2013 None
N/A
CORTLAND
NY
ACTIVE
12/4/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
4/27/2009 None
N/A
6/15/2011 None
N/A
HOUSTON
NEPHROLOGY
HOUSTON
SAN ANTONIO
WHEELING
MUSCULOSKELETAL
IMAGING
HOUSTON
DALLAS
TX
TX
TX
TX
WV
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
SPINAL CORD
INJURY MEDICINE
ACTIVE
INTERNAL MEDICINE SHREVEPORT LA
Page 294 of 300
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
LUBBOCK
tx
LUBBOCK
TX
DEL RIO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
9/20/2010
11/23/2012
11/10/2011
12/13/2012
1/16/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
8/26/2011 None
N/A
2/4/2011 None
1/25/2011 None
N/A
N/A
10/23/2012 None
N/A
5/6/2011 None
N/A
10/15/2010 None
1/21/2011 None
5/14/2009 None
N/A
N/A
N/A
8/30/2013 None
N/A
7/26/2010 None
N/A
License
Number
Physician Name
Registration
dicaid
dicaid
Status of
Agreement
Practice
Texas
Start Date
End Date
Designated)
(Self-Designated)
Practice City
State
License
CARDIOVASCULAR
LICENSE
1/4/2013
1/4/2018 DISEASES
INTERNAL MEDICINE
ISSUED
PEDIATRIC CRITICAL
4/9/2010
PEDIATRICS
SAN ANTONIO TX
ACTIVE
1/3/2011
HOUSTON
TX
ACTIVE
P5249
YARLAGADDA, ANITHA, MD
N6113
N8474
YARROZU, ABEL RAJESH, MD
YAU, RAYMOND M, MD
P5763
YAVROUIAN, ERIC JOHN, MD
3/1/2013
N6114
N7376
YAZDANI, AMIR , MD
YEDLAPALLI, LATHA, MD
4/9/2010
8/2/2010
N9988
6/3/2011
4/8/2011
4/8/2016 CARDIOLOGY
P6752
YEGANEH, MELINA , MD
YELAMANCHILI, PRIDHVI
RAJAKUMAR, MD
YELVERTON, BRYAN CHARLES,
MD
GASTROENTEROLOG
6/3/2016 Y
N8160
P0522
YELVERTON, DAVID P, MD
YEMME, SOUMYA, MD
P0523
YEO, ALBERT, MD
7/15/2011
P4626
YEPEZ GUEVARA, EDUARDO, MD
10/1/2012
N9666
P2176
N7981
P6558
YI, ZANHUA, MD
YIN, VIVIAN TSUI-WEN, MD
YIN, ZHENGNAN , MD
YIP-DAVILA, DAVID K, MD
N5498
YOHO, JASON ALLEN, MD
2/5/2010
N8875
YOLLAND, MICHAEL , MD
2/15/2011
P0155
YOO, DALE, MD
6/15/2011
P4533
YOO, JI WON, MD
9/17/2012
N6115
YOOSEFIAN, FARIDA , MD
N9425
5/15/2013
11/15/2010
7/15/2011
5/2/2011
2/10/2012
10/15/2010
5/1/2013
4/9/2010
EMERGENCY
11/15/2015 MEDICINE
SPORTS MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
1/4/2013 None
N/A
4/15/2010 None
1/25/2011 None
N/A
N/A
3/19/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/9/2010 None
8/17/2010 None
N/A
N/A
TX
ACTIVE
6/17/2011 None
N/A
ACTIVE
4/22/2011 None
N/A
SAN ANTONIO TX
ACTIVE
5/17/2013 None
N/A
ADDISON
TX
ACTIVE
ACTIVE
11/22/2010 None
7/21/2011 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
7/20/2011 None
N/A
NEW YORK
NY
ACTIVE
11/1/2012 None
N/A
HOUSTON
HOUSTON
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/8/2011
2/27/2012
11/1/2010
5/9/2013
None
None
None
None
N/A
N/A
N/A
N/A
2/5/2010 None
N/A
2/15/2011 None
N/A
TX
ACTIVE
6/20/2011 None
N/A
IL
ACTIVE
LICENSE
ISSUED
9/24/2012 None
N/A
4/9/2010 None
N/A
OTOLARYN & FACIAL
PLASTIC SURGERY
PEDIATRIC ANES
(PEDS)
HOSPITALIST
SUNNYVALE
HOUSTON
FAMILY PRACTICE
HEMATOLOGY/ONCOL
5/2/2016 OGY
INTERNAL MEDICINE
ONCOLOGY
CARDIOVASCULAR
2/5/2015 DISEASES
INTERNAL MEDICINE
CARDIAC
ELECTROPHYSIOLOG CARDIOVASCULAR
6/15/2016 Y
DISEASES
DALLAS
GERIATRIC
MEDICINE (INTERNAL
CHICAGO
Page 295 of 300
License
Number
N6783
Physician Name
YORK, CORTNIE, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
6/4/2010
6/4/2015 MEDICINE
P3599
YOUNES, HOUSSAM KHALED, MD
6/8/2012
P1440
YOUNG ACHONG MEJIA, ANGELA
MARIA, MD
11/4/2011
11/4/2016 NEUROLOGY
P4838
YOUNG, ALISHA YI-WEN, MD
11/1/2012
P1154
YOUNG, CARLA L, MD
10/3/2011
PHYSICAL MED. &
N6116
YOUNG, CATHERINE ALICE, MD
4/9/2010
N7893
N9796
YOUNG, DAYTON LEONARD, MD
YOUNG, DIANE B, MD
10/1/2010
5/16/2011
N6784
YOUNG, KAVON LYNETTE, MD
6/4/2010
P0325
YOUNGBLOOD, SLOAN CURRY, MD
7/1/2011
P2405
P2562
YOUNGDAHL, MARCY EILEEN, MD
YOUNUS, SIDRA , MD
3/1/2012
3/15/2012
P7053
YOUSAF, SHAGUFTA, MD
6/14/2013
N1965
YOUSSEF, EMAD FOUAD, MD
P2406
N7513
P7054
P7730
N4865
N7894
YOUSUF, SHUJA, MD
YSSA, MARIA D, MD
YU, FANG , MD
YU, MICHAEL Z, MD
YU, MUJUN, MD
YU, SAN-SAN, MD
3/1/2012
8/16/2010
6/14/2013
8/15/2013
11/6/2009
10/1/2010
3/1/2017
8/16/2015
6/14/2018
8/15/2018
11/6/2014
10/1/2015
P7873
YUKSEL, SANCAK , MD
8/30/2013
P6302
YURATICH, DANE MARIE, MD
4/12/2013
12/12/2008
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
MAMMOGRAPHY
OTOLOGY/NEUTOTO
LOGY
BERTHOUD
GERIATRIC MEDICINE
FAMILY MEDICINE
N/A
ACTIVE
6/11/2012 None
N/A
TX
ACTIVE
11/7/2011 None
N/A
TX
ACTIVE
12/12/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
10/12/2011 None
N/A
4/9/2010 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
10/20/2010 None
5/20/2011 None
N/A
N/A
6/4/2010 None
N/A
8/5/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/12/2012 None
4/2/2012 None
N/A
N/A
6/14/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
1/30/2009 None
N/A
4/9/2015 RADIOLOGY
RADIATION
12/12/2013 ONCOLOGY
CO
HOUSTON
TX
AUSTIN
TX
PEDIATRICS
PHOENIX
INTERNAL MEDICINE
FAMILY MEDICINE
RADIOLOGY
INTERNAL MEDICINE
PATHOLOGY
ANESTHESIOLOGY
CYTOPATHOLOGY
PEDIATRIC
OTOLARYNGOLOGY
Page 296 of 300
Disciplinary
Status Date
6/4/2010 None
VASCULAR
SURGERY
NEURO-PHYSIOLOGY
(NEUROLOGY)
DALLAS
PALLIATIVE
MEDICINE
DALLAS
PAIN
MANAGEMENT/REHA
B MED
ARLINGTON
Registration
Status Date
Disciplinary
Status of
Texas
License
AZ
PHARR
SAN ANTONIO
HOUSTON
ROSWELL
AUSTIN
TX
TX
TX
NM
TX
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
3/1/2012
8/19/2010
6/20/2013
8/20/2013
11/19/2009
10/20/2010
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
9/2/2013 None
N/A
4/12/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6118
YUST, ELIZABETH MARIE, MD
4/1/2013
N8072
P6559
YUSUF, HARAR , MD
ZABAK, ELAINA M, MD
P7731
ZACHARATOS, HARALABOS, DO
8/15/2013
P3493
ZACHARIAH, AMIT ABRAHAM, MD
6/1/2012
10/29/2010
5/1/2013
P7230
ZACHARIAH, AVEEN BABU, DO
7/1/2013
P3494
ZACHRISON, JAMIE VERNER, MD
6/1/2012
N1500
ZAFAR, NADAH BANO, MD
N6787
ZAHARIA, ADRIAN , MD
P3271
N4221
10/10/2008
4/1/2018 PEDIATRICS
5/1/2018 RADIOLOGY
FAMILY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
EMERGENCY
10/10/2013 MEDICINE
ZAHEDI, MOJDEH , MD
ZAHEER, AYESHA NAWAZ, MD
5/15/2012
8/21/2009
N7193
N7379
ZAHEER, IRUM, MD
ZAHID, KANWAL, MD
7/15/2010
8/2/2010
N1236
ZAIDI, SYED , MD
ZAIDI, SYED MUHAMMAD HAMMAD
ALI, MD
8/29/2008
11/4/2011
4/2/2012
6/4/2010
9/15/2011
P2814
N6791
ZAKY SALAMA, WADID, MD
ZALAVARRIA, JONARD HERBIAS,
MD
P1034
ZAMAN, TARIQ UZ, MD
N8476
ZAMIR, SYED SHAN, MD
1/3/2011
N9014
ZAMORA, GUS , MD
3/1/2011
Practice City
HOUSTON
TX
DALLAS
TX
8/15/2018 NEUROLOGY
6/4/2010
P1441
Secondary Specialty
(Self-Designated)
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Registration
Status of
Practice
Texas
State
License
FAMILY
PRACTICE/OMM
KYLE
TX
GERIATRIC
MEDICINE (INTERNAL
MED)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
SAINT LOUIS MO
SAN ANTONIO TX
NEPHROLOGY
GENERAL PRACTICE
INTERVENTIONAL
1/3/2016 RADIOLOGY
RADIOLOGY
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
3/1/2016 GYNECOLOGY
SURGERY
Page 297 of 300
TYLER
TX
THE
WOODLANDS TX
MUSKOGEE
OK
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/2/2013 None
N/A
10/29/2010 None
6/27/2013 None
N/A
N/A
8/15/2013 None
N/A
ACTIVE
6/12/2012 None
N/A
ACTIVE
7/9/2013 None
N/A
ACTIVE
6/8/2012 None
N/A
ACTIVE
10/24/2008 None
N/A
6/4/2010 None
N/A
5/22/2012 None
10/2/2009 None
N/A
N/A
7/15/2010 None
8/5/2010 None
N/A
N/A
9/8/2008 None
N/A
11/30/2011 None
N/A
4/2/2012 None
N/A
6/4/2010 None
N/A
ACTIVE
9/19/2011 None
N/A
ACTIVE
2/9/2011 None
N/A
ACTIVE
3/11/2011 None
N/A
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
P0811
ZAMORA, IRVING JOSE, MD
N6118
dicaid
dicaid
Agreement
End Date
Designated)
8/15/2011
P7874
ZAMORA, JESUS GABRIEL, MD
ZANDOMENI, GABRIELA MONIKA,
MD
ZAPATA ANTIGONI, CARLOS
FERNANDO, MD
8/30/2013
P1155
ZARATE CACERES, HERNAN
ALEXANDER, MD
10/3/2011
N9989
4/9/2010
6/3/2011
4/9/2015 RADIOLOGY
OBSTETRICS AND
6/3/2016 GYNECOLOGY
PULMONARY
CRITICAL CARE
10/3/2016 MEDICINE
8/21/2009
8/29/2008
7/1/2011
P1717
P7231
ZEATER, MOHAMED YASER, MD
ZEHM, CHARLES FLOYD, MD
12/15/2011
7/1/2013
7/1/2016 PEDIATRICS
PULMONARY
CRITICAL CARE
12/15/2016 MEDICINE
N1967
P1035
ZEHR, KENTON JAMES, MD
ZEINEDDINE, SALAM, MD
12/12/2008
9/15/2011
N2895
ZELISKO, MICHAEL BLAINE, MD
4/3/2009
P0524
ZELLE, BORIS ALEXANDER, MD
7/15/2011
N9015
3/1/2011
N7600
ZENOOZ, NAVID ALIYARI, MD
ZERTUCHE SANCHEZ, AURORA
DENISE, MD
8/27/2010
P0525
ZEVALLOS, JOSE PEDRO, MD
7/15/2011
N6795
ZGOURIDES, GEORGE DEAN, MD
N4867
ZHAN, MAOCHENG , MD
11/6/2009
P0526
ZHANG, ANDREW YUAN, MD
7/15/2011
P5764
ZHANG, HAIYING , MD
ORTHOPEDIC
7/15/2016 TRAUMA
3/1/2016 RADIOLOGY
N/A
ACTIVE
6/16/2011 None
N/A
ACTIVE
9/9/2013 None
N/A
ACTIVE
11/21/2011 None
N/A
FORT WORTH TX
ABILENE
TX
HARLINGEN
TX
ACTIVE
ACTIVE
ACTIVE
8/31/2009 None
9/15/2008 None
7/8/2011 None
N/A
N/A
N/A
GALVESTON
TX
LICENSE
ISSUED
ACTIVE
12/15/2011 None
7/3/2013 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
3/4/2009 None
9/26/2011 None
N/A
N/A
TX
ACTIVE
4/14/2009 None
N/A
SAN ANTONIO TX
MUSCULOSKELETAL PALM
RADIOLOGY
SPRINGS
CA
ACTIVE
7/20/2011 None
N/A
ACTIVE
4/12/2011 None
N/A
ACTIVE
9/2/2010 None
N/A
8/9/2011 None
N/A
6/4/2010 None
N/A
TX
GASTROENTEROLOG
Y
SPORTS MEDICINE
(FAMILY PRACTICE)
LONGVIEW
OTORHINOLARYNGOL
7/15/2016 OGY
HOUSTON
TX
BURLESON
LAKE
CHARLES
TX
ACTIVE
LICENSE
ISSUED
LA
ACTIVE
1/6/2010 None
N/A
HAND SURGERY SURGERY
GALVESTON
TX
ACTIVE
7/20/2011 None
N/A
CYTOPATHOLOGY
HOUSTON
TX
ACTIVE
3/4/2013 None
N/A
PLASTIC &
RECONSTRUCTIVE
7/15/2016 SURGERY
ANATOMIC/CLINICAL
3/1/2018 PATHOLOGY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/29/2011 None
N/A
4/9/2010 None
ROWLETT
ZAROSKY, JOHN MATTHEW, MD
ZAUSMER, GLENN DUANE, DO
ZEAGER, MICHELLE ANN, DO
3/1/2013
Practice City
HOUSTON
NEURORADIOLOGY
N4224
N1238
P0326
6/4/2010
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
Page 298 of 300
License
Number
Physician Name
dicaid
dicaid
Agreement
Practice
Start Date
End Date
Designated)
(Self-Designated)
Practice City
State
HEMATOLOGY/ONCOL
4/13/2012
4/13/2017 OGY
TX
8/21/2009
RICHARDSON TX
PHYSICAL MED. &
2/5/2010
7/1/2013
7/1/2018 PATHOLOGY
HOUSTON
TX
P2936
N4225
ZHANG, JIANJUN , MD
ZHANG, JINSONG , MD
N5508
P7232
ZHANG, LING , MD
ZHANG, MIAO, MD
N8599
ZHANG, SONGLIN, MD
1/18/2011
1/18/2016 PATHOLOGY
P7875
ZHANG, WEI, MD
8/30/2013
P6304
ZHANG, YUANHUI , MD
4/12/2013
8/30/2018 PATHOLOGY
PHYSICAL MED. &
N4226
ZHAO, GUANGQUAN , MD
8/21/2009
N6121
ZHAO, JEFF XINDA, DO
P7598
P1252
ZHAO, WEI, MD
ZHENG, GANG, MD
P6560
ZHENG, KE, MD
P0527
P4840
ZHOU, CONSTANCE QINGYUN, MD
ZHOU, LI, MD
7/15/2011
11/1/2012
P4841
ZHU, HAO, MD
11/1/2012
4/9/2010
8/1/2013
10/17/2011
5/1/2013
N8600
P7373
ZHUK, STANISLAV A, MD
ZIBDEH-LOUGH, HANA ISAM, DO
1/18/2011
7/15/2013
P5502
ZIDE, JACOB ROTHSCHILD, MD
2/1/2013
N7382
P3106
ZIEGLER, JORDAN I, MD
ZIMILEVICH, ALEXANDER, MD
P6755
N7517
CYTOPATHOLOGY
ORTHOPEDIC
4/9/2015 SURGERY
ALLERGY AND
8/1/2018 IMMUNOLOGY
EMERGENCY
5/1/2018 MEDICINE
OTORHINOLARYNGOL
7/15/2016 OGY
HEMATOLOGY/ONCOL
11/1/2017 OGY
8/2/2010
5/1/2012
8/2/2015
5/1/2017
ZIMMER, BRIAN MATTHEW, DO
5/15/2013
5/15/2018
ZIMMERMAN, BRETT EATON, MD
8/16/2010
8/16/2015
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
INTERNAL MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
SHREVEPORT LA
N/A
N/A
2/5/2010 None
8/5/2013 None
N/A
N/A
8/30/2013 None
N/A
TX
ACTIVE
4/18/2013 None
N/A
TX
ACTIVE
10/2/2009 None
N/A
ACTIVE
4/23/2010 None
N/A
ACTIVE
ACTIVE
9/9/2013 None
10/25/2011 None
N/A
N/A
ACTIVE
5/13/2013 None
N/A
ACTIVE
ACTIVE
7/27/2011 None
11/29/2012 None
N/A
N/A
ACTIVE
11/8/2012 None
N/A
LA
ACTIVE
ACTIVE
2/14/2011 None
7/25/2013 None
N/A
N/A
MD
ACTIVE
2/5/2013 None
N/A
TX
ACTIVE
ACTIVE
9/13/2010 None
5/4/2012 None
N/A
N/A
AMARILLO
TX
ACTIVE
5/20/2013 None
N/A
VICTORIA
TX
ACTIVE
9/17/2010 None
N/A
RICHMOND
HOUSTON
NEW
ORLEANS
FOOT AND ANKLE,
ORTHOPEDICS
BALTIMORE
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
AUSTIN
HOSPITALIST
Page 299 of 300
4/13/2012 None
9/7/2009 None
N/A
VA
TX
TX
IL
INTERNAL MEDICINE
FAMILY MEDICINE
Disciplinary
Status Date
2/1/2011 None
IRVING
OPHTHALMOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
AMARILLO
HEMATOLOGY/ONCO
LOGY
DALLAS
PEDIATRICS
Registration
Status of
Texas
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
N7601
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
8/27/2015
3/1/2013
8/1/2011
3/1/2018
8/1/2016
5/2/2011
7/1/2011
5/2/2016
7/1/2016
8/15/2011
8/15/2016
Practice City
LICENSE
ISSUED
P5765
P0688
ZIMMERMAN, CINDY LOU, MD
ZIMMERMAN, MICHAEL PATRICK,
MD
ZINDANI, SHIREEN, MD
N9667
P0327
ZINK, CHRISTINE LABENZ, MD
ZINK, WALTER EARL III, MD
P0812
ZISSIMOS, ANTHONY GEORGE, MD
P1718
12/15/2011
12/15/2016
P2178
N7896
ZIU, MATEO , MD
ZIWORITIN, DAMA ALEXANDER,
MD
ZON, JENNIFER T, MD
2/10/2012
10/1/2010
2/10/2017
10/1/2015
N6797
P5150
P5150
P5150
ZONIES, DAVID , MD
ZUBAIR, SALMAN, MD
ZUBAIR, SALMAN, MD
ZUBAIR, SALMAN, MD
6/4/2010
12/17/2012
12/17/2012
12/17/2012
6/4/2015
12/17/2017
12/17/2017
12/17/2017
N6798
ZUBAY, GEOFFREY PYONG, MD
6/4/2010
N7194
ZULUAGA, MARIA TERESA, MD
ZURITA SAAVEDRA, AMADO
JAVIER, MD
7/15/2010
SURGICAL CRITICAL
TRAUMATIC SURGERY CARE
NEUROLOGY
OKC
NEUROLOGY
OKC
NEUROLOGY
OKC
NEUROLOGICAL
6/4/2015 SURGERY
PEDIATRIC CRITICAL
9/15/2010
9/15/2015 ONCOLOGY
N7768
8/27/2010
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
INTERNAL MEDICINE
EMERGENCY
MEDICINE
RADIOLOGY
ORTHOPEDIC
SURGERY
NEUROLOGICAL
SURGERY
OBSTETRICS AND
GYNECOLOGY
FAMILY MEDICINE
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
NEURO-RADIOLOGY
SPORTS MEDICINE
(ORTH SURG)
ROUND ROCK TX
ACTIVE
ACTIVE
4/2/2013 None
8/5/2011 None
N/A
N/A
SAN ANTONIO TX
SAN ANTONIO TX
ACTIVE
ACTIVE
5/19/2011 None
7/7/2011 None
N/A
N/A
BRYAN
TX
ACTIVE
8/23/2011 None
N/A
SAN ANTONIO TX
ACTIVE
1/5/2012 None
N/A
ELKO
DALLAS
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/20/2012 None
10/4/2010 None
N/A
N/A
HOUSTON
Page 300 of 300
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
8/27/2010 ORDER
8/30/2010
NV
TX
OK
OK
OK
TX
ACTIVE
6/4/2010
12/21/2012
12/21/2012
12/21/2012
None
None
None
None
N/A
N/A
N/A
N/A
6/4/2010 None
N/A
7/15/2010 None
N/A
9/20/2010 None
N/A

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