Provider Demographics
NPI:1093017063
Name:SOUTHEAST TEXAS CLINICAL RESEARCH AND EDUCATION INC
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS CLINICAL RESEARCH AND EDUCATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKE
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:832-226-7412
Mailing Address - Street 1:5925 ALMEDA RD
Mailing Address - Street 2:NORTH TOWER SUITE 717
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7602
Mailing Address - Country:US
Mailing Address - Phone:832-226-7412
Mailing Address - Fax:
Practice Address - Street 1:5925 ALMEDA RD
Practice Address - Street 2:NORTH TOWER SUITE 717
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7602
Practice Address - Country:US
Practice Address - Phone:832-226-7412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM99902086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty