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General NPI Number Information
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NPI Number | 1689960361
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Entity Type | Organization
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Legal Business Name | NEUROLOGY DIAGNOSTIC CENTERS OF TEXAS, PA
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 5959 WEST LOOP S SUITE 302
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City | BELLAIRE
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State | TX
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Zip | 77401-2421
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Country | US
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Telephone | 713-481-1016
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Fax | 713-481-4608
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Provider Business Mailing Address
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Address Line | 5959 WEST LOOP S SUITE 302
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City | BELLAIRE
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State | TX
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Zip | 77401-2421
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Country | US
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Telephone | 713-481-1016
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Fax | 713-481-4608
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Authorized Official
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Title or Position | NEURODIAGNOTIC SPECIALIST
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Name | MIKE WATSON
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Credential |
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Telephone | 713-835-2607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State | TX
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