Healthcare Provider Details

I. General information

NPI: 1558500041
Provider Name (Legal Business Name): ALEXANDER KELLEY MEDICALLY SUPERVISED WEIGHT LOSS PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2009
Last Update Date: 02/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S VOSS RD SUITE 200
HOUSTON TX
77057-1086
US

IV. Provider business mailing address

1415 S VOSS RD SUITE 200
HOUSTON TX
77057-1086
US

V. Phone/Fax

Practice location:
  • Phone: 713-781-5566
  • Fax: 713-554-1837
Mailing address:
  • Phone: 713-781-5566
  • Fax: 713-554-1837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberH9747
License Number StateTX

VIII. Authorized Official

Name: VICTORIA L ALEXANDER
Title or Position: PARTNER
Credential: MD
Phone: 713-781-5566