MEDICARE: HOUSTON NORTHEAST ALLERGY, P. A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	F1107	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0031KN	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588614291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON NORTHEAST ALLERGY, P. A.

Provider Business Mailing Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:	SUITE #290
City	:	HUMBLE
State	:	TX
Zip	:	77339-4438
Country	:	US
Telephone Number	:	281-348-3321
Fax Number	:	281-348-3305

Provider Business Practice Location Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:	SUITE #290
City	:	HUMBLE
State	:	TX
Zip	:	77339-4438
Country	:	US
Telephone Number	:	281-348-3321
Fax Number	:	281-348-3305

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. LOUIS CLAUDE LAROSE
Credential	:	M.D.
Telephone Number	:	281-348-3321

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/04/2008

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Directions to “HOUSTON NORTHEAST ALLERGY, P. A. ” Practice Location

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