Provider Demographics
NPI:1316015837
Name:FAMILY PRACTICE CLINIC OF ALVIN PA
Entity Type:Organization
Organization Name:FAMILY PRACTICE CLINIC OF ALVIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-331-5953
Mailing Address - Street 1:711 W SIDNOR
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511
Mailing Address - Country:US
Mailing Address - Phone:281-331-5953
Mailing Address - Fax:281-331-2221
Practice Address - Street 1:711 W SIDNOR
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511
Practice Address - Country:US
Practice Address - Phone:281-331-5953
Practice Address - Fax:281-331-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty