=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114244258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEVERLY J LALLANDE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2010
-----------------------------------------------------
Last Update Date | 04/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6945 BURGESS ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77021-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-252-7256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6945 BURGESS ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77021-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-252-7256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BEVERLY J LALLANDE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 713-252-7256
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | M8110
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------