Healthcare Provider Details

I. General information

NPI: 1306096003
Provider Name (Legal Business Name): LIVER & DIGESTIVE CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12060 BELLAIRE BLVD SUITE A
HOUSTON TX
77072-2569
US

IV. Provider business mailing address

12060 BELLAIRE BLVD SUITE A
HOUSTON TX
77072-2569
US

V. Phone/Fax

Practice location:
  • Phone: 281-983-0205
  • Fax: 281-983-0385
Mailing address:
  • Phone: 281-983-0205
  • Fax: 281-983-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberJ2237
License Number StateTX

VIII. Authorized Official

Name: MS. JACKIE M LE
Title or Position: OFFICE MANAGER
Credential:
Phone: 281-983-0205