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General NPI Number Information
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NPI Number | 1023047941
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC IMAGINING SPECIALIST
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 2323 E. HWY 35
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City | ANGLETON
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State | TX
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Zip | 77515-3804
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Country | US
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Telephone | 979-849-2738
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Fax | 979-849-3625
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Provider Business Mailing Address
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Address Line | 2323 E. HWY 35
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City | ANGLETON
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State | TX
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Zip | 77515
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Country | US
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Telephone | 979-849-2738
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Fax | 979-849-3625
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | LARRY K PARKER
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Credential | M.D.
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Telephone | 832-618-9046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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