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General NPI Number Information
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NPI Number | 1003626219
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Entity Type | Organization
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Legal Business Name | MODERN MEDICINE ASSOCIATES PLLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 6565 WEST LOOP S STE 525
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City | BELLAIRE
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State | TX
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Zip | 77401-3519
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Country | US
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Telephone | 713-661-7888
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Fax | 713-661-7899
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Provider Business Mailing Address
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Address Line | 6565 WEST LOOP S STE 525
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City | BELLAIRE
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State | TX
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Zip | 77401-3519
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Country | US
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Telephone | 713-661-7888
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Fax | 713-661-7899
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Authorized Official
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Title or Position | MEMBER/PHYSICIAN
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Name | DR. BO J ALLAIRE
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Credential | MD
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Telephone | 713-661-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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