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General NPI Number Information
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NPI Number | 1053012955
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Entity Type | Organization
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Legal Business Name | VIGOR TESTOSTERONE AND WEIGHT LOSS LLC
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 12804 GULF FWY STE 200
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City | HOUSTON
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State | TX
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Zip | 77034-4850
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Country | US
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Telephone | 832-472-0135
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Fax |
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Provider Business Mailing Address
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Address Line | 12806 BIG SPRING TRL
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City | HUMBLE
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State | TX
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Zip | 77346-4048
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Country | US
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Telephone | 832-472-0135
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN M LEONDIKE
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Credential | NP
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Telephone | 832-472-0135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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