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General NPI Number Information
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NPI Number | 1649256546
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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 | 12/22/2005
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 505 S NOLEN DR STE A
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9167
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Country | US
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Telephone | 817-424-1525
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Fax | 817-424-3491
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Provider Business Mailing Address
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Address Line | 950 E STATE HIGHWAY 114 STE 200
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5261
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Country | US
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Telephone | 214-424-2200
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Fax | 214-231-2159
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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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