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General NPI Number Information
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NPI Number | 1093017063
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Entity Type | Organization
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Legal Business Name | SOUTHEAST TEXAS CLINICAL RESEARCH AND EDUCATION INC
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 5925 ALMEDA RD NORTH TOWER SUITE 717
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City | HOUSTON
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State | TX
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Zip | 77004-7602
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Country | US
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Telephone | 832-226-7412
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Fax |
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Provider Business Mailing Address
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Address Line | 5925 ALMEDA RD NORTH TOWER SUITE 717
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City | HOUSTON
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State | TX
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Zip | 77004-7602
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Country | US
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Telephone | 832-226-7412
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CORNELIUS DYKE I
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Credential | MD
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Telephone | 832-226-7412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | M9990
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License Number State | TX
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