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General NPI Number Information
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NPI Number | 1386992980
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Entity Type | Organization
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Legal Business Name | PROTEOME DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 79 N. MISTY MORNING TRACE
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City | SPRING
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State | TX
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Zip | 77381
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Country | US
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Telephone | 281-465-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 79 N. MISTY MORNING TRACE
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City | SPRING
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State | TX
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Zip | 77381
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Country | US
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Telephone | 281-465-0335
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL SUBACH
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Credential | PH. D.
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Telephone | 281-465-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 291U00000X
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License Number State | TX
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