MEDICARE: DIABETES CENTER OF WELLNESS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	464138	OTHER	LA	NPI

General Provider Information

NPI Number	:	1255094645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES CENTER OF WELLNESS, P.A.

Provider Business Mailing Address
First Line	:	10490 HUFFMEISTER RD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-5654
Country	:	US
Telephone Number	:	832-280-5447
Fax Number	:

Provider Business Practice Location Address
First Line	:	10490 HUFFMEISTER RD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-5654
Country	:	US
Telephone Number	:	832-280-5447
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY P MORAN
Credential	:	MD
Telephone Number	:	832-915-2363

Provider Enumeration Date	:	10/21/2021
Last Update Date	:	10/21/2021

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Directions to “DIABETES CENTER OF WELLNESS, P.A. ” Practice Location

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