Provider Demographics
NPI:1033439781
Name:LAKESIDE GASTROENTEROLOGY AND LIVER SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:LAKESIDE GASTROENTEROLOGY AND LIVER SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAJONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-530-5310
Mailing Address - Street 1:86 LENOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:690 S LOOP 336 W STE 215
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3322
Practice Address - Country:US
Practice Address - Phone:936-828-3962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty