Healthcare Provider Details

I. General information

NPI: 1104047018
Provider Name (Legal Business Name): DCOA PHYSICIAN ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12266 FM 1960
HOUSTON TX
77065
US

IV. Provider business mailing address

13100 NORTHWEST FREEWAY SUITE # 400
HOUSTON TX
77040
US

V. Phone/Fax

Practice location:
  • Phone: 713-840-5110
  • Fax: 287-469-9119
Mailing address:
  • Phone: 832-237-3500
  • Fax: 281-897-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHUCK DOWLING
Title or Position: CEO
Credential:
Phone: 713-840-5333