Healthcare Provider Details

I. General information

NPI: 1467129387
Provider Name (Legal Business Name): COMMONS IOM TECH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 COLLEGE PARK DR STE 101B
THE WOODLANDS TX
77384-4001
US

IV. Provider business mailing address

13236 N. 7TH ST. SUITE 4 #289
PHOENIX AZ
85022
US

V. Phone/Fax

Practice location:
  • Phone: 832-871-4609
  • Fax: 832-871-4609
Mailing address:
  • Phone: 832-871-4609
  • Fax: 832-871-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMILY LAWLER
Title or Position: PRINCIPLE PARTNER
Credential:
Phone: 314-378-5422