DR. JOHN MATHEW POOTHULLIL M.D.,F.R.C.P,F.A.A.P

Allergy and Immunology

Lake Jackson, Texas

Provider NPI: 1134102528

Provider Information:
DR. JOHN MATHEW POOTHULLIL M.D.,F.R.C.P,F.A.A.P


Practice Location:
201 OAK DR S SUITE 106 LAKE JACKSON, TX 77566 US
Tel: 979-297-8006  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	207K00000X	Physicians Allergy & Immunology	TX	E6880

Other Provider Identifiers:

Issuer	Number	State	Type
AMERIKIDS	10020011	TX	01
CIGNA HMO	02914600-13	TX	01
BCBS BLUE LINK	2225592	TX	01
CIGNA	02914600-01	TX	01
CIGNA SELECT	02914600-14	TX	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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