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General NPI Number Information
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NPI Number | 1518042035
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Entity Type | Individual
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Provider Name | SIDDHARTH R DAVE D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 1309 FM 1092 RD
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City | MISSOURI CITY
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State | TX
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Zip | 77459-1504
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Country | US
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Telephone | 713-461-2915
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 STARBOARD SHORES DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-1722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K4035
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License Number State | TX
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