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General NPI Number Information
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NPI Number | 1568283422
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Entity Type | Organization
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Legal Business Name | TEXAS DIGESTIVE DISEASE CONSULTANTS PLLC
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 2080 S CLINTON AVE
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City | ROCHESTER
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State | NY
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Zip | 14618-5703
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Country | US
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Telephone | 585-271-2800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 206239
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City | DALLAS
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State | TX
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Zip | 75320-6239
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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 | CREDENTIALING MANAGER
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Name | KRISTINA KAY LOWERY
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Credential |
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Telephone | 469-930-3077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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