Provider Demographics
NPI:1154315414
Name:LE, DI VAN (MD)
Entity Type:Individual
Prefix:
First Name:DI
Middle Name:VAN
Last Name:LE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 BLOSSOM ST
Mailing Address - Street 2:STE 400
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4204
Mailing Address - Country:US
Mailing Address - Phone:281-604-1300
Mailing Address - Fax:281-724-0225
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:STE 400
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:281-604-1300
Practice Address - Fax:281-724-0225
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2022-01-28
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Provider Licenses
StateLicense IDTaxonomies
TXG4157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080132114OtherRAILROAD MEDICARE
TX87286JOtherBCBS
TX5842696OtherAETNA
TX098508701Medicaid
TX87591ZOtherHMO BLUE
TX098508701Medicaid
TXE78725Medicare UPIN