MEDICARE: TEXAS DIGESTIVE DISEASE CONSULTANTS PLLC

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1568283422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS DIGESTIVE DISEASE CONSULTANTS PLLC

Provider Business Mailing Address
First Line	:	950 E STATE HIGHWAY 114 STE 200
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-5261
Country	:	US
Telephone Number	:	214-424-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 S CLINTON AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5703
Country	:	US
Telephone Number	:	585-271-2800
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	KRISTINA KAY LOWERY
Credential	:
Telephone Number	:	469-930-3077

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	04/21/2026

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