MEDICARE: LONG POINT M.D. 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	208D00000X	General Practice Physician	D4359	TX

General Provider Information

NPI Number	:	1770804296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG POINT M.D. P.A.

Provider Business Mailing Address
First Line	:	8153 LONG POINT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2032
Country	:	US
Telephone Number	:	713-722-8799
Fax Number	:	713-722-8830

Provider Business Practice Location Address
First Line	:	8153 LONG POINT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2032
Country	:	US
Telephone Number	:	713-722-8799
Fax Number	:	713-722-8830

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. ROBERT G. WILKERSON
Credential	:
Telephone Number	:	713-722-8799

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	06/18/2010

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