Provider Demographics
NPI:1073707394
Name:E. LEON ETTER II MD PA
Entity Type:Organization
Organization Name:E. LEON ETTER II MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEGY
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:ETTER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:713-739-1391
Mailing Address - Street 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:SUITE 1708
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-739-1391
Mailing Address - Fax:713-759-0786
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 1708
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-739-1391
Practice Address - Fax:713-759-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3336208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W298Medicare UPIN