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General NPI Number Information
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NPI Number | 1831483494
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Entity Type | Organization
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Legal Business Name | NORTHWEST ENDO SURGICAL PLLC
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 18220 STATE HIGHWAY 249 STE. 300
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City | HOUSTON
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State | TX
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Zip | 77070-4347
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Country | US
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Telephone | 281-921-1890
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Fax | 281-921-1897
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Provider Business Mailing Address
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Address Line | 18220 STATE HIGHWAY 249 STE. 300
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City | HOUSTON
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State | TX
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Zip | 77070-4347
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Country | US
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Telephone | 281-921-1890
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Fax | 281-921-1897
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Authorized Official
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Title or Position | OWNER/ PHYSICIAN
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Name | MATTHEW J ST. LAURENT
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Credential | MD
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Telephone | 281-921-1890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | J4536
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License Number State | TX
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